Liver transplantation for alcoholic cirrhosis: long term follow-up and impact of disease recurrence.
Liver transplantation for alcoholic cirrhosis: long term follow-up and impact of disease recurrence.
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肝移植治疗酒精性肝硬化：长期随访和疾病复发的影响。
DOI：
10.1097/00007890-200108270-00010
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发表时间：
2001
期刊：
影响因子：
6.2
通讯作者：
Demetris,AJ
中科院分区：
文献类型：
--
作者：
Bellamy,CO;DiMartini,AM;Ruppert,K;Jain,A;Dodson,F;Torbenson,M;Starzl,TE;Fung,JJ;Demetris,AJ
背景：酒精性肝病已成为肝移植的主要适应症，尽管这是一种有争议的资源使用。我们的目标是检查与酒精滥用相关的肝移植的方方面面。方法：对123名酒精中毒患者进行了回顾性队列分析，平均随访时间为7年。结果：除了酒精，43名患者(35%)还有另一种可能的因素导致肝硬变。患者和移植物的精算存活率分别为84%和81%(1年)；72%和66%(5年)；63%和59%(7年)。移植后18例(15%)出现21例非皮肤原发恶性肿瘤，明显多于对照组(P=0.0001)，上消化道鳞癌过多(P=0.03)。13名患者明确复发，另有3名患者被怀疑复发。每日酒精消耗量(P=0.0314)可预测复发，但移植前戒酒时间或外植体组织学不能预测复发。移植后无一例发生酒精性肝炎，迟发性急性排斥反应和慢性排斥反应均未见明显增加。多因素回归分析显示，肝移植失败的预测因素主要为胆道/血管并发症(P=0.002.0 1)、肝活检时慢性胆管损伤(P=0.0 5)和肝细胞周围纤维化(P=0.0 5)；移植物病毒性肝炎在单因素分析中略有意义(P=0.0 7)。反复发作的酒精性肝病本身并不是移植物病理或失败的重要原因。在移植前，应该对潜在的受者进行严格的筛查，看是否有并存的情况(如丙型肝炎、代谢性疾病)和其他靶器官损害，特别是空气消化系统恶性肿瘤，这些疾病比反复发生的酒精性肝病更容易导致发病率和死亡率。
Background.Alcoholic liver disease has emerged as a leading indication for hepatic transplantation, although it is a controversial use of resources. We aimed to examine all aspects of liver transplantation associated with alcohol abuse.Methods.Retrospective cohort analysis of 123 alcoholic patients with a median of 7 years follow-up at one center.Results.In addition to alcohol, 43 (35%) patients had another possible factor contributing to cirrhosis. Actuarial patient and graft survival rates were, respectively, 84% and 81%(1 year); 72% and 66%(5 years); and 63% and 59%(7 years). After transplantation, 18 patients (15%) manifested 21 noncutaneous de novo malignancies, which is significantly more than controls (P= 0.0001); upper aerodigestive squamous carcinomas were overrepresented (P= 0.03). Thirteen patients had definitely relapsed and three others were suspected to have relapsed. Relapse was predicted by daily ethanol consumption (P= 0.0314), but not by duration of pretransplant sobriety or explant histology. No patient had alcoholic hepatitis after transplantation and neither late onset acute nor chronic rejection was significantly increased. Multiple regression analyses for predictors of graft failure identified major biliary/vascular complications (P= 0.01), chronic bile duct injury on biopsy (P= 0.002), and pericellular fibrosis on biopsy (P= 0.05); graft viral hepatitis was marginally significant (P= 0.07) on univariate analysis.Conclusions.Alcoholic liver disease is an excellent indication for liver transplantation in those without coexistent conditions. Recurrent alcoholic liver disease alone is not an important cause of graft pathology or failure. Potential recipients should be heavily screened before transplantation for coexistent conditions (eg, hepatitis C, metabolic diseases) and other target-organ damage, especially aerodigestive malignancy, which are greater causes of morbidity and mortality than is recurrent alcohol liver disease.
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作者：
Rogers,AE;Conner,MW
通讯作者：
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DOI：
10.1111/j.1530-0277.1996.tb01695.x
发表时间：
1996-12-01
影响因子：
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DOI：
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1999
期刊：
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作者：
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D. Sherman;Roger Williams
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