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Operative techniques of liver re-transplantation: a report of 32 cases

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Author:
No author available
Journal Title:
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
Issue:
1
DOI:
10.3760/cma.j.issn.0254-1785.2010.01.005
Key Word:
肝移植;再手术;治疗效果;Liver transplantation;Reoperation;Treatment outcome

Abstract: Objective To explore the operative techniques and clinical effectiveness of liver re-transplantation. Methods The clinical data of 31 patients undergoing 32 liver re-transplantations were analyzed retrospectively. All the patients received modified piggyback liver transplantation with venacavaplasty,and extracorporeal venous bypass was used in 11 cases. For arterial reconstruction,the artery jump graft with the aorta was done in 24 patients, except end-to-end in 8 patients. Biliary reconstruction was performed by Roux-en-Y choledochojejunostomy in 28 patients,except duct-to-duct without T-tube in 4 patients. All of the patients routinely received anti-rejection and anti-infection treatments after operation,and long-term follow-up. Results Over all, 17 patients died after operation with the survival time ranging from 2 weeks to 28 months. The most common causes of death after operation were sepsis (8 cases),multiple organ failure and recurrence of HCC (3 cases each) .vascular complications and intracranial hemorrhages (1 case each). The mortality rate of during operation in these patients receiving re-transplantation between 8 and 30 days after their initial transplantation was the highest (66. 7 %). Other 14 patients were cured with the survival time being from 1 to 29 months with good liver function and quality of life. No significant difference was found in operative time and blood loss between liver re-transplantation and primary transplantation. Conclusion Modified piggyback liver transplantation with venacavaplasty is especially advantageous for liver re-transplantation. Proper indication and individualized treatments are the key for success of liver re-transplantation. Compared to primary liver transplantation, liver re-transplantation has higher morbidity and mortality.

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