摘要
目的 探讨肝移植术后晚期导致患者死亡的主要原因 ,提出预防的方法。方法 回顾性分析1981年 2月— 1998年 4月在美国匹斯堡大学进行的生存期大于 1年的 2 94 0例肝移植长期随访结果 ,分析其主要死因与相关因素。结果 1981— 1991年 10年肝移植术后病死率呈逐年降低趋势 ,从 2 0 .4 %降到 1.9% ;术后晚期 (存活期 >1年 )死亡者 817例 ,主要死因依次为恶性肿瘤 (复发 +新生 ,2 0 .7% )、心血管并发症( 11.4 % )、各种感染 ( 11.3% )和呼吸系统并发症 ( 9.4 % )。随着免疫抑制剂使用情况的变化 ,1981— 1986年为环胞素 / Cy A,1986— 1990年为 OKT3/ Viaspan,1991— 1998年为 Tarolim us/ FK5 0 6 ,各期 1、5、10年病死率呈逐年下降趋势。术后 1、5、10、15和 18年病死率以 3～ 18岁年龄为低 ,19～ 6 0岁年龄组 10、15、18年病死率最高。病死率最高的肝移植指征为恶性肿瘤和暴发性肝功能衰竭 ,酒精性肝硬化术后随时间延长病死率逐年增加 ,13年最高 (达 76 .0 % )。结论 肝移植术后期主要死因为新生恶性肿瘤、心血管并发症、各种感染和呼吸系统并发症 ;
Objective To evaluate the cause of late mortality in liver transplant recipients, and to study the prevention and management of these complications. Methods Two thousand nine hundred and forty patients who underwent liver transplantation at University of Pittsburgh and survived more than 1 year between February 1981 and April 1998 were included in this study. Cause of death, and other relative factors were analyzed. Results The rate of death dramatically decreased from 20 4% to 1 9% during that 10 years(19811991). Eight hundred and seventeen patients who survived more than 1 year had died during the followup period. The causes of death were malignant tumor (20 7%), cardiovascular complication (11 4%), infection (11 3%), and respiratory system complications (9 4%). Following the change in the immunosuppression protocol(19811986 was cyclosporinA, 19861990 was OKT3, 19911998 was FK506), the 1year death rate, 5year death rate, and 10year death rate were constantly decreased postoperatively . Patients of 318year old group had the lowest mortality rate, while that of 1960year old group had the highest mortality rate. The patients who received liver transplantation because hepatic carcinoma or fulminant hepatic failure had the highest mortality after the operation. Mortality of the patients who received liver transplantation because of alcoholic cirrhosis increased gradually year by year. Conclusion Malignant tumor, cardiovascular complication, infection and respiratory system complications are the most common causes of late mortality after liver transplantation. Early diagnosis and treatment can improve the survival rate.
出处
《中国危重病急救医学》
CAS
CSCD
2004年第9期547-551,共5页
Chinese Critical Care Medicine
基金
天津市科技发展计划重点攻关项目 (993 113 111)
关键词
肝移植
死亡原因
并发症
liver transplantation
cause of death
complication
