成人再次肝移植研究进展

吴若林; 赵红川; 耿小平

doi:10.3969/j.issn.1674-7445.2024040

成人再次肝移植研究进展

doi: 10.3969/j.issn.1674-7445.2024040

230022　合肥，安徽医科大学第一附属医院肝胆胰及移植外科

基金项目: 安徽省自然科学基金青年基金项目（2008085QH361）

详细信息

作者简介:

通讯作者:
赵红川（ORCID 0000-0001-5170-5789），Email：zhc0117@sina.com

中图分类号: R617, R575
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出版历程
- 收稿日期: 2024-03-15
- 刊出日期: 2024-07-15

Research progress in adult liver retransplantation

Department of Hepatobiliary Pancreatic and Transplantation Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China

More Information

Corresponding author: Zhao Hongchuan, Email: zhc0117@sina.com

摘要

摘要: 再次肝移植是肝移植术后移植肝衰竭的唯一治愈性手段。首次肝移植与再次肝移植间隔时间的长短，将直接影响成人再次肝移植的手术适应证、技术难度和治疗转归。既往多项研究认为再次肝移植术后移植肝及受者总体生存率明显低于首次肝移植，但随着器官保存方法、麻醉管理理念、重症监护策略、外科手术技术和新型免疫抑制药等各个领域的全面进步，成人再次肝移植的疗效显著提高。本文就成人再次肝移植手术适应证的变迁、手术时机的选择、长期疗效及其影响因素、手术技术难点、免疫抑制方案的选择以及活体再次肝移植的开展情况进行评述，总结目前成人肝移植取得的成果、面临的挑战及潜在解决方案，以期为提高成人再次肝移植的临床疗效提供参考。
- 再次肝移植 /
- 移植肝衰竭 /
- 活体肝移植 /
- 免疫抑制 /
- 免疫诱导 /
- 排斥反应 /
- 手术并发症 /
- 疾病复发
Abstract: Liver retransplantation is the final option for graft failure after liver transplantation. The interval between the first and second liver transplantation will directly affect surgical indications, technical difficulties and treatment outcomes of adult liver retransplantation. Previous studies have shown that the overall survival of liver allografts and recipients after liver retransplantation is significantly lower than that after the first liver transplantation. However, with comprehensive progress in organ preservation methods, anesthesia management concepts, intensive care strategies, surgical techniques and new immunosuppressive drugs, clinical efficacy of adult liver retransplantation has been significantly improved. In this article, the changes of indications, timing of operation, long-term efficacy and its influencing factors, technical difficulties, selection of immunosuppressive regimens and the implementation of living donor liver retransplantation were reviewed, and the achievements, challenges and potential solutions of adult liver retransplantation were summarized, aiming to provide reference for enhancing clinical efficacy of adult liver retransplantation.
- Liver retransplantation /
- Liver graft failure /
- Living donor liver transplantation /
- Immunosuppression /
- Immune induction /
- Rejection /
- Surgical complication /
- Disease recurrence

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参考文献(38)

[1]	STARZL TE, IWATSUKI S, VAN THIEL DH, et al. Evolution of liver transplantation[J]. Hepatology, 1982, 2(5): 614-636. DOI: 10.1002/hep.1840020516.
[2]	YOUNG K, LIU B, BHUKET T, et al. Lower likelihood of post-transplant graft failure, death, and retransplantation in the era of direct-acting antivirals[J]. J Clin Exp Hepatol, 2020, 10(6): 581-589. DOI: 10.1016/j.jceh.2020.02.003.
[3]	DAKROUB A, ANOUTI A, COTTER TG, et al. Mortality and morbidity among adult liver retransplant recipients[J]. Dig Dis Sci, 2023, 68(10): 4039-4049. DOI: 10.1007/s10620-023-08065-2.
[4]	MEZOCHOW AK, ABT PL, BITTERMANN T. Differences in early immunosuppressive therapy among liver retransplantation recipients in a national cohort[J]. Transplantation, 2021, 105(8): 1800-1807. DOI: 10.1097/ TP.0000000000003417.
[5]	KULIK U, LEHNER F, KLEMPNAUER J, et al. Primary non-function is frequently associated with fatty liver allografts and high mortality after re-transplantation[J]. Liver Int, 2017, 37(8): 1219-1228. DOI: 10.1111/liv.13404.
[6]	张龙, 韩国勇, 陈志强, 等. 再次肝移植治疗慢性移植物功能衰竭4例报告及文献复习[J]. 南京医科大学学报(自然科学版), 2024, 44(2): 247-252. DOI: 10.7655/NYDXBNSN230913. ZHANG L, HAN GY, CHEN ZQ, et al. Report and research progress on liver re-transplantation for chronic graft failure in 4 cases[J]. J Nanjing Med Univ, 2024, 44(2): 247-252. DOI: 10.7655/NYDXBNSN230913.
[7]	HALLE-SMITH JM, HALL LA, HANN A, et al. Emergency retransplant for primary non-function of liver allograft[J]. Br J Surg, 2023, 110(10): 1267-1270. DOI: 10.1093/bjs/znad110.
[8]	杨梦凡,王睿,潘斌华,等. 脂肪变性供肝用于肝癌肝移植的预后及影响因素多中心研究[J].中华消化外科杂志, 2022, 21(2): 237-248. DOI: 10.3760/cma.j.cn115610-20220209-00072. YANG MF, WANG R, PAN BH, et al. Analysis of influencing factors for anastomotic biliary stricture after liver transplantation[J]. Chin J Dig Surg, 2022, 21(2): 237-248. DOI: 10.3760/cma.j.cn115610-20220209-00072.
[9]	KURAMITSU K, FUKUMOTO T, EGAWA H, et al. A multicenter Japanese survey assessing the long-term outcomes of liver retransplantation using living donor grafts[J]. Transplantation, 2020, 104(4): 754-761. DOI: 10.1097/TP.0000000000002958.
[10]	NEVES SOUZA L, DE MARTINO RB, SANCHEZ-FUEYO A, et al. Histopathology of 460 liver allografts removed at retransplantation: a shift in disease patterns over 27 years[J]. Clin Transplant, 2018, 32(4): e13227. DOI: 10.1111/ctr.13227.
[11]	PAWLICKI J, KUREK A, KRÓL R. Evaluation of early and late effects of surgical treatment of early hepatic artery thrombosis after liver transplantation[J]. Transplant Proc, 2022, 54(4): 1037-1041. DOI: 10.1016/j.transproceed.2022.03.016.
[12]	YOON PD, PATEL MS, MURILLO PEREZ CF, et al. Outcomes of adult liver retransplantation: a Canadian national database analysis[J]. Can J Gastroenterol Hepatol, 2022: 9932631. DOI: 10.1155/2022/9932631.
[13]	JEFFREY AW, DELRIVIERE L, MCCAUGHAN G, et al. Excellent contemporary graft survival for adult liver retransplantation: an Australian and New Zealand registry analysis from 1986 to 2017[J]. Transplant Direct, 2019, 5(8): e472. DOI: 10.1097/TXD.00000 00000000920.
[14]	CROOME KP, MATHUR AK, PUNGPAPONG S, et al. Equivalent outcomes with retransplantation and primary liver transplantation in the direct-acting antiviral era[J]. Transplantation, 2019, 103(6): 1168-1174. DOI: 10.1097/TP.0000000000002460.
[15]	PHILIP G, HOOKEY L, RICHARDSON H, et al. Alcohol-associated liver disease is now the most common indication for liver transplant waitlisting among young American adults[J]. Transplantation, 2022, 106(10): 2000-2005. DOI: 10.1097/TP.0000000000004202.
[16]	FALARI SS, MOHAPATRA N, PATIL NS, et al. Incidence and predictors of alcohol relapse following living donor liver transplantation for alcohol related liver disease[J]. J Hepatobiliary Pancreat Sci, 2023, 30(8): 1015-1024. DOI: 10.1002/jhbp.1325.
[17]	COTTER TG, ODENWALD MA, LIEBER SR, et al. The practice of retransplantation for recurrent alcohol-associated liver disease in the United States is uncommon with acceptable outcomes[J]. Transplant Direct, 2022, 8(3): e1297. DOI: 10.1097/TXD.0000000000 001297.
[18]	VISSEREN T, ERLER NS, POLAK WG, et al. Recurrence of primary sclerosing cholangitis after liver transplantation - analysing the European Liver Transplant Registry and beyond[J]. Transpl Int, 2021, 34(8): 1455-1467. DOI: 10.1111/tri.13925.
[19]	HENSON JB, PATEL YA, KING LY, et al. Outcomes of liver retransplantation in patients with primary sclerosing cholangitis[J]. Liver Transpl, 2017, 23(6): 769-780. DOI: 10.1002/lt.24703.
[20]	LÓPEZ MJC, FRANCO CC, ARTACHO GS, et al. Results of early liver retransplantation[J]. Transplant Proc, 2020, 52(5): 1486-1488. DOI: 10.1016/j.transproceed. 2020.02.055.
[21]	SHIMADA S, SHAMAA T, IVANICS T, et al. Effects of the implementation of acuity circle policy on waitlist and post-transplant outcomes of liver re-transplantation[J]. Clin Transplant, 2023, 37(6): e14977. DOI: 10.1111/ctr.14977.
[22]	ABBASSI F, GERO D, MULLER X, et al. Novel benchmark values for redo liver transplantation: does the outcome justify the effort?[J]. Ann Surg, 2022, 276(5): 860-867. DOI: 10.1097/SLA.0000000000005634.
[23]	LLADÓ L, LOPEZ-DOMINGUEZ J, RAMOS E, et al. Is liver retransplantation justified in the current era?[J]. Cir Esp (Engl Ed), 2021, 99(5): 339-345. DOI: 10.1016/j.ciresp.2020.06.023.
[24]	SMOTER P, KRASNODĘBSKI M, FIGIEL W, et al. The effect of early retransplantation on early and late survival after liver transplantation[J]. Transplant Proc, 2022, 54(4): 1007-1010. DOI: 10.1016/j.transproceed.2022.03.018.
[25]	BRAUN HJ, GRAB JD, DODGE JL, et al. Retransplantation after living donor liver transplantation: data from the adult to adult living donor liver transplantation study[J], Transplantation, 2021, 105(6): 1297-1302. DOI: 10.1097/ TP.0000000000003361.
[26]	TRIGUERO CABRERA J, ZAMBUDIO CARROLL N, GONZÁLEZ MARTÍNEZ S, et al. Analysis of indications and results in liver retransplantation: is late retransplantation worthwhile?[J]. Transplant Proc, 2018, 50(2): 598-600. DOI: 10.1016/j.transproceed.2017.12.055.
[27]	RHU J, KWON J, LIM M, et al. Graft-recipient-weight ratio and lowered immunosuppression is important for the success of adult liver retransplantation[J]. Sci Rep, 2023, 13(1): 12778. DOI: 10.1038/s41598-023-39007-7.
[28]	BRUBALLA R, SANCHEZ THOMAS D, DE SANTL'BANES E, et al. Liver re-transplantation in adults: indications and outcomes analysis of a 23-year experience in a single center in Argentina[J]. Int J Organ Transplant Med, 2022, 13(2): 30-35.
[29]	AKABANE M, BEKKI Y, IMAOKA Y, et al. Has the risk of liver re-transplantation improved over the two decades?[J]. Clin Transplant, 2023, 37(12): e15127. DOI: 10.1111/ctr.15127.
[30]	IVANICS T, RIZZARI M, MOONKA D, et al. Retransplantation outcomes for hepatitis C in the United States before and after direct-acting antiviral introduction[J]. Am J Transplant, 2021, 21(3): 1100-1112. DOI: 10.1111/ajt.16254.
[31]	KUSEJKO K, NEOFYTOS D, HIRSCH HH, et al. Differences between infectious disease events in first liver transplant versus retransplantation in the Swiss transplant cohort study[J]. Liver Transpl, 2021, 27(9): 1283-1290. DOI: 10.1002/lt.26068.
[32]	CONNOR AA, SAHARIA A, MOBLEY CM, et al. Modern outcomes after liver retransplantation: a single-center experience[J]. Transplantation, 2023, 107(7): 1513-1523. DOI: 10.1097/TP.0000000000004500.
[33]	夏强,沙朦. 活体肝移植的进展与展望[J]. 中华消化外科杂志, 2022, 21(1): 39-42. DOI: 10.3760/cma.j.cn115610-20211205-00622. XIA Q, SHA M. Progress and prospect of living donor liver transplantation[J]. Chin J Dig Surg, 2022, 21(1): 39-42. DOI: 10.3760/cma.j.cn115610-20211205-00622.
[34]	POLAT KY, YAZAR Ş, KARGI A, et al. Comparing the outcomes of deceased-donor and living-donor liver re-transplantation in adult patients[J]. Transplant Proc, 2023, 55(5): 1193-1198. DOI: 10.1016/j.transproceed.2023.01.039.
[35]	IVANICS T, LIMKEMANN A, PATEL MS, et al. Long-term outcomes of retransplantation after live donor liver transplantation: a Western experience[J]. Surgery, 2023, 173(2): 529-536. DOI: 10.1016/j.surg.2022.09.022.
[36]	邢皓, 陶一峰, 徐琳琳, 等. 器官捐献时代再次肝移植单中心回顾性研究[J/OL]. 中华移植杂志(电子版), 2020, 14(6): 343-348. DOI: 10.3877/cma.j.issn.1674-3903.2020.06.002. XING H, TAO YF, XU LL, et al. Single-center retrospective analysis of liver retransplantation in the era of organ donation[J/OL]. Chin J Transplant (Electr Edit), 2020, 14(6): 343-348. DOI: 10.3877/cma.j.issn.1674-3903.2020.06.002.
[37]	LAROCHE S, MAULAT C, KITANO Y, et al. Initial piggyback technique facilitates late liver retransplantation - a retrospective monocentric study[J]. Transpl Int, 2021, 34(5): 835-843. DOI: 10.1111/tri.13857.
[38]	孙晓叶, 沈中阳. 再次肝移植术后免疫抑制剂的应用分析[J/OL]. 实用器官移植电子杂志, 2019, 7(2): 95-98. DOI: 10.3969/j.issn.2095-5332.2019.02.008. SUN XY, SHEN ZY. Application analysis of immunosuppressive agents after liver retransplantation[J/OL]. Pract J Organ Transplant (Electr Vers), 2019, 7(2): 95-98. DOI: 10.3969/j.issn.2095-5332.2019.02.008.