Complications after liver transplantation

doi:10.3969/j.issn.2095-4344.2013.18.007

Abstract

Abstract:

BACKGROUND: The complicated operation process and easy production of complications of orthotropic liver transplantation limit the successful rate of liver transplantation.
OBJECTIVE: To investigate the common reasons and prevention and treatment of complications after liver transplantation.
METHODS: Clinical data of 59 cases (53 males and six females) with complications in 176 liver transplantation patients were analyzed retrospectively, the age of the 59 patients were 25-74 years, averaged in (46.41±12.02) years. Ten cases had the parimary disease of hepatitis B cirrhosis (hepatitis B merger renal failure in one case), seven cases had cirrhosis complicated hepatocellular carcinoma, four cases had biliary cirrhosis, one case had alcoholic cirrhosis, 13 patient had hepatocellular carcinoma, one case had cholangiocarcinoma, three cases had hepatolenticular degeneration, 13 patients had liver failure and 47 patients had severe hepatitis B (severe hepatitis B combined with renal failure in one case). All the donors and recipients were in line with the principle of blood type matching.
RESULTS AND CONCLUSION: A total of 102 cases of complications occurred, including abdominal cavity bleeding (15 cases), upper gastrointestinal bleeding (five cases), pulmonary infection (21 cases), abdominaI infection (five cases), biliary complications (21 cases), chronic rejection (three cases), acute rejection (ten cases), acute renal insufficiency (seven cases), hepatitis B virus recurrence (three cases), neuropsychopathic complications (six cases), primary nonfunction (four cases), inferior vena cava thrombosis (one case), graft-versus-host reaction (one case). A total of 24 patients died during perioperative period, abdominal cavity bleeding (six cases), pulmonary infection (six cases), primary nonfunction (four cases), multiple organ dysfunction syndrome (three cases), abdominaI infection (one case), graft-versus-host reaction (one case), crdiac arrest (one case), biliary necrosis (one case), subarachnoid hemorrhage (one case). Emphasis on perioperative period management of liver transplantation patients, to improve the liver function, to correct the coagulation, to improve the nutrition and the infection control, as well as the improvement of surgical techniques and timely diagnosis and treatment of the complications are the keys to improve the success rate of liver transplantation.

Key words: organ transplantation, liver transplantation, perioperative period, complication, Child-Pugh classification, serum bilirubin, serum albumin, prothrombin time, hepatic encephalopathy, provincial grants-supported paper

CLC Number:

R318

Yu Zhong-shan, Jiang Yi, Cai Qiu-cheng, Yang Fang, Lü Li-zhi. Complications after liver transplantation[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(18): 3275-3282.

Figures/Tables 3

感染并发症：26例。肺部感染21例，发生率20.6%。3例EB病毒感染、1例巨细胞病毒感染治愈。1例继发肺结核，给予抗结核治疗后痊愈，1例肺部隐球菌感染，行胸腔镜下切除局部病灶后治愈，1例鲍曼不动杆菌肺炎，肝移植后34 d因无敏感抗生素治疗死亡。7例因脓毒血症死亡。7例治愈。腹腔感染5例，发生率4.9%。腹腔感染的诊断标准[4]：符合以下条件之一：①术后3 d起出现发热(T > 38 ℃)、血白细胞计数> 10×109 L-1，腹痛、腹胀伴明显的腹膜炎体征。②腹腔引流液为脓性液体，细菌培养结果阳性。③影像学检查或再次手术证实腹腔内有感染病变存在，如化脓性渗出、脓肿等。5例均有腹腔液/腹腔引流管细菌培养结果，2例肺炎克雷伯杆菌，1例溶血性葡萄球菌，1例路邓葡萄球菌，1例溶血性葡萄球菌合并白色念珠菌。结果1例腹腔双套管持续负压引流冲洗、抗感染等治疗后治愈，4例死亡。胆道并发症：21例，发生率20.6%。胆漏8例，7例治痊，1例因胆漏后继发腹腔大出血死亡。胆管狭窄5例治愈。胆泥或胆管结石8例治愈。排斥反应：13例。急性排斥10例，发生率9.8%。9例逆转，1例对激素治疗抵抗，肝移植后10 d因心脏骤停死亡。3例慢性排斥给予FK506及激素治疗，1例至今仍在随访，2例死亡。移植物抗宿主病1例，因感染和多器官功能衰竭死亡。急性肾功能衰竭：7例，发生率6.9%。1例给予床边持续血滤后治愈，3例因肺部感染死亡，2例因移植肝无功能等死亡，1例因心脏骤停死亡。乙肝复发：3例，复发率为2.9%。本中心术后定期检测HBV-DNA拷贝数，肝移植后发现拷贝数明显升高，考虑对拉米夫定耐药，本中心对拉米夫定耐药者改用恩替卡韦抗病毒，治疗后拷贝数下降至正常。1例于移植术后48个月因私自停用拉米夫定抗病毒，导致乙肝复发引起急性肝功能衰竭死亡。另2例服用拉米夫定抗病毒，肝移植后11个月及移植后18个月后乙肝复发，改用恩替卡韦抗病毒，1例肝移植后13月因肿瘤复发死亡，1例肝移植后23月因肺部感染死亡。其他并发症：下腔静脉血栓形成1例，给予抗凝、口服华法令治愈。桥脑中央髓鞘融解症1例，肝移植后48 d因脑部并发症死亡。蛛网膜下腔出血1例，肝移植后10 d死亡，脑梗死合并重度昏迷1例，肝移植后7d因移植肝无功能死亡。1例代谢性脑病，肝移植前合并肝性脑病，移植后给予改善循环、营养神经、补充B族维生素、叶酸等治疗后治愈。1例肝性脑病，肝移植后5 d因多器官功能衰竭死亡。 2.3 患者生存率围手术期存活152例，生存率86.36%，死亡24例，死亡率13.67%。围手术期死亡原因见表3。随访期死亡20例，死亡原因见表4。目前存活132例，总生存率75.00%，存活超过1年的118例，2年76例，3年33例，4年6例，最长1例已存活4年8个月。"

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