■肝移植是挽救肝移植失败患者的唯一选择。然而,与初次移植相比,它的生存结果较差,因此存在争议。台湾死者器官捐赠不足导致候补死亡率高。因此,活体移植为再移植提供了一种有价值的选择.本研究旨在分析单个中心在活体供肝再移植(re-LDLT)和死亡供肝再移植(re-DDLT)中的结局以及与生存相关的混杂危险因素。
■这是一项单中心回顾性研究,包括2002年6月至2020年4月接受肝脏再移植(re-LT)的32名成年人。将该队列分为再LDLT组和再DDLT组,并分析生存结果。不同时期的患者结局,时间对生存的影响,和多变量分析的危险因素也被证明。
■在32次移植中,再LDLT组(n=11)接受了来自年轻捐赠者的移植物(31.3vs.43.75年,P=0.016),移植物重量较低(688vs.1,457.2g,P<0.001)和较短的冷缺血时间(CIT)(45vs.313分钟,P<0.001)。再LDLT组的5年生存率明显优于再DDLT组(100%vs.70.8%,P=0.02)。当仅分析2010年后的再移植时,这种差异得到了调整。进一步的分析表明,再移植的时机(早期与晚期)不影响患者生存率。多因素分析显示,热缺血时间(WIT)延长和术中输血与长期生存不良有关。
■用活体供体移植的再移植显示出良好的长期结果,对受体和供体均具有可接受的并发症。它可以作为缺乏已故捐赠者的地区的一种选择。再次移植的时机不影响长期存活。应进一步努力减少WIT和大量输血,因为它们导致再移植后的存活率低下。
UNASSIGNED: Liver retransplant is the only option to save a patient with liver graft failure. However, it is controversial due to its poor survival outcome compared to primary transplantation. Insufficient deceased organ donation in Taiwan leads to high waitlist mortality. Hence, living-donor grafts offer a valuable alternative for
retransplantation. This study aims to analyze the single center\'s outcome in living donor liver
retransplantation (re-LDLT) and deceased donor liver
retransplantation (re-DDLT) as well as the survival related confounding risk factors.
UNASSIGNED: This is a single center retrospective study including 32 adults who underwent liver retransplantation (re-LT) from June 2002 to April 2020. The cohort was divided into a re-LDLT and a re-DDLT group and survival outcomes were analyzed. Patient outcomes over different periods, the effect of timing on survival, and multivariate analysis for risk factors were also demonstrated.
UNASSIGNED: Of the 32 retransplantations, the re-LDLT group (n=11) received grafts from younger donors (31.3 vs. 43.75 years, P=0.016), with lower graft weights (688 vs. 1,457.2 g, P<0.001) and shorter cold ischemia time (CIT) (45 vs. 313 min, P<0.001). The 5-year survival was significantly better in the re-LDLT group than in the re-DDLT group (100% vs. 70.8%, P=0.02). This difference was adjusted when only
retransplantation after 2010 was analyzed. Further analysis showed that the timing of retransplantation (early vs. late) did not affect patient survival. Multivariate analysis revealed that prolonged warm ischemia time (WIT) and intraoperative blood transfusion were related to poor long-term survival.
UNASSIGNED: Retransplantation with living donor graft demonstrated good long-term outcomes with acceptable complications to both recipient and donor. It may serve as a choice in areas lacking deceased donors. The timing of
retransplantation did not affect the long-term survival. Further effort should be made to reduce WIT and massive blood transfusion as they contributed to poor survival after retransplantation.