Silviu Gligor, M.D., Ibtesam Hilmi, M.B., Ch.B., F.R.C.A., Daniela Damian, M.D., Tetsuro Sakai, M.D., Raymond M. Planinsic, M.D.
麻醉科，匹兹堡大学医学中心，匹兹堡，宾夕法尼亚。
简介：肝心同步联合移植或肝肺同步联合移植是一项罕见而又及其复杂的手术。根据美国器官共享网络（UNOS）的报道，全美范围内共进行了46例肝心联合移植和20例心肺联合移植，均为成人患者。在此项回顾性研究中，我们比较了联合移植的疗效与原发性原位肝移植（OLT）的疗效，手术均在同一所单一成人移植中心进行。
方法：在过去的17年间（1989-2006），共有14名成人患者（10名为男性）进行了同步联合移植手术。其中，肝-心联合移植10例，心-肾-肝联合移植1例，心-双肺-肝联合移植1例，双肺-肝联合移植2例。肝功能衰竭的病原学原因为淀粉样病变（4例）、坏死后肝硬化（4例）、原发性胆汁性肝硬化（2例）、囊性纤维变性（2例）、血色病（1例）、布-加氏综合征（1例）。我们对比了联合移植对照组的疗效和进行配型的14例原发性OLT的疗效。配型的标准为移植的时间、年龄、性别、MELD评分、国际标准化比值（INR）、和肝脏病理学。我们运用t-test或费歇尔精确检验进行统计分析，同时将Kaplan-Meier法用于患者和移植术后存活的患者。P值小于0.05被认为有统计学意义。表1中的数据为平均值±标准差。
结果：
表1.研究结果显示，对照组中的患者存活率更高，但是因为案例数量较少，尚未达到统计学意义【图1】
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联合移植(n=14)
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原位肝移植(n=14)
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P 值
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移植肝冷缺血时间(分钟)
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588.43±111.20
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688.21±241.59
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0.177
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手术中的血细胞(单位)
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11.46±7.16
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8.79±5.79
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0.22
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手术中的新鲜冷冻血浆(单位)
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11.46±7.16
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9.00±8.00
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0.409
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手术中的血小板(单位)
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9.85±8.72
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5.86±5.11
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0.156
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血清乳酸盐(肝脏再灌注后5分钟)
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14.21±6.78∗
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5.65±4.01
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0.01
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血清乳酸盐(肝脏再灌注后30分钟)
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13.4±6.65∗
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5.30±4.50
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0.013
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ICU停留时间(天)
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22.15±28.27
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7.36±12.43
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0.536
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住院时间(天)
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63.08±59.96∗
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15.93±12.75
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0.037
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ICU使用呼吸机时间(天)
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17.69±25.24
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6.79±14.52
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0.163
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术后肾脏替代疗法
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5
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2
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0.378
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感染发作(术后第一个月)
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2
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2
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1
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移植后存活(肝脏)
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78.60%
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71.40%
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0.619
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患者存活
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65.30%
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78.60%
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0.447
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∗p<0.05有统计学意义
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Simultaneous Combined Heart-Liver and Lung-Liver Transplantation Outcomes
Silviu Gligor, M.D., Ibtesam Hilmi, M.B., Ch.B., F.R.C.A., Daniela Damian, M.D., Tetsuro Sakai, M.D., Raymond M. Planinsic, M.D.
Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Introduction: Simultaneous combined heart-liver or lung-liver transplantation is an rare and complicated surgical procedure. The United Network for Organ Sharing (UNOS) reports that a total of 46 heart-liver and 20 lung-liver transplantations have been performed nationwide in adult patients. In this retrospective study, the outcome of the combined transplant procedures in a single adult transplantation center was compared to that of primary orthotopic liver transplantation (OLT).
Method: 14 adults (10 males) underwent simultaneous combined transplantations during a 17-year period (1989-2006). Among them, heart-liver transplantations was performed in 10, heart-kidney-liver in 1, heart-double lung-liver in 1, and double lung-liver in 2 patients. The etiology of liver failure was amyloidosis (4), postnecrotic liver cirrhosis (4), primary biliary cirrhosis (2), cystic fibrosis (2), hemochromatosis (1), and Budd-Chiarri syndrome (1). Outcome of the combined transplantation group was compared to that of a case-matched control group of 14 primary OLT. The matching criteria were the year of transplantation, age, sex, MELD score, INR, and liver pathology. For statistical analysis, t-test or Fisher exact test were used. Kaplan-Meier method was used for patient and graft survival. P value less than 0.05 was considered statistically significant. Data in the table1 are presented as mean ± SD.
Results: [table1]There was a trend for better patient survival in the control group, but this did not reach statistical significance due to the small number of cases.[figure1]
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Combined (n=14)
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OLT (n=14)
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P value
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Cold Ischemic Time for liver graft (min)
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588.43±111.20
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688.21±241.59
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0.177
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Intra-operative Red Blood Cells (units)
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11.46±7.16
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8.79±5.79
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0.22
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Intra-operative Fresh Frozen Plasma (units)
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11.46±7.16
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9.00±8.00
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0.409
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Intra-operative Platelets (units)
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9.85±8.72
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5.86±5.11
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0.156
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Serum Lactate (5 min after the liver reperfusion)
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14.21±6.78∗
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5.65±4.01
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0.01
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Serum Lactate (30 min after liver reperfusion)
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13.4±6.65∗
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5.30±4.50
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0.013
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ICU Stay (days)
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22.15±28.27
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7.36±12.43
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0.536
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Hospital Stay (days)
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63.08±59.96∗
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15.93±12.75
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0.037
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Ventilator Stay in ICU (days)
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17.69±25.24
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6.79±14.52
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0.163
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Postoperative Renal Replacement Therapy
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5
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2
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0.378
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Infection episodes (1st month postoperative)
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2
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2
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1
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Graft Survival (liver)
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78.60%
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71.40%
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0.619
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Patient Survival
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65.30%
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78.60%
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0.447
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∗=p<0.05 statistically significant
[责任编辑:刘 聪]
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