印度活体肝脏再移植的第一个系列：挑战和结果。

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Clinical and Experimental Hepatology Pub Date : 2024-11-10 DOI:10.1016/j.jceh.2024.102454

Shaleen Agarwal , Rajesh Dey , Sanjiv Saigal , Phani K. Nekarakanti , Subash Gupta

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引用次数: 0

摘要

背景：印度缺乏活体供肝移植（LDLT）后长期生存或再次移植（re-LT）需要的数据。在这篇文章中，我们报道了印度的第一批再移植手术，重点是适应证、技术挑战和结果。方法：回顾性分析29例肝再移植（re-LT）患者的生存结局和术后并发症。根据首次移植后30天内或30天以上是否进行再移植，将患者分为早期和晚期再移植组。结果：3563例肝移植（28例活体供肝，1例死亡供肝）中，29例（0.81%）再次行肝移植。27例（93%）患者原发移植为LDLT。第一次移植后中位时间为26天再次移植。17例（59%）患者在早期（30天内）进行了Re-LT， 12例（41%）患者在晚期（超过30天）进行了Re-LT。肝动脉血栓形成（53%）和早期移植物功能障碍（47%）是早期再移植的指征，而胆道并发症（50%）和慢性排斥反应（33%）是晚期再移植的主要指征。22例（75%）患者出现移植后并发症，最常见的是革兰氏阴性细菌性败血症。再移植后30天死亡率为27%（8/29）。死亡的主要原因是革兰氏阴性败血症。晚期再移植组的死亡率（2.16.6%）低于早期再移植组（6.35%）。结论：适当选择既往LDLT患者，活体供体再移植是一种可行的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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First Series of Living Donor Liver Retransplants From India: Challenges and Outcomes

Background

There is a paucity of Indian data on long-term survival after living donor liver transplant (LDLT) or the need for retransplant (re-LT). In this article, we report the first series of retransplants from India with focus on indications, technical challenges and results.

Methods

A retrospective study on 29 patients undergoing a liver retransplant (re-LT) was analysed with respect to survival outcomes and postoperative complications. Patients were divided into early and late retransplant groups based on whether re-LT was performed within or beyond 30 days of primary transplant.

Results

Liver retransplant was performed in 29 (0.81%) patients out of a total of 3563 liver transplants (28 living donor and one deceased donor liver transplant). The primary transplant was an LDLT in 27 (93%) patients. Retransplant was performed at a median of 26 days after the first transplant. Re-LT was performed early (within 30 days) in 17 (59%) patients and late (beyond 30 days) in 12 (41%). Hepatic artery thrombosis (53%) and early graft dysfunction (47%) were the indications for early retransplant, while biliary complications (50%) and chronic rejection (33%) were primary indications for late retransplant. Postretransplant complications occurred in 22 (75%) patients, the commonest being gram-negative bacterial sepsis. The 30-day mortality after retransplant was 27% (8/29). The primary cause of mortality was gram-negative septicaemia. The mortality in the late retransplant group (2, 16.6%) was lower than in the early retransplant group (6, 35%).