Ching Chan, Barbara Chik, Chi Leung Liu, Chung Mau Lo, Sheung Tat Fan. 肝胆胰腺外科，外科，香港大学医疗中心，香港

简介：十年前开展的成人-成人活体肝右叶移植现正准备接受中期成果的评价。

患者和方法：1996年5月至2004年12月期间在香港大学玛丽医院的肝移植患者，至少连续随访2年（188例）。受体和移植特征的数据是有计划收集的，之后又进行了回顾性分析。从1996年到2000年，每年有少于30例被确认为早期。

结果：平均随访时间为48个月，其中28例早期，160例晚期。早期受体稍微年轻（早期42 岁，晚期48 岁，p = 0.002），并且患肝细胞癌的较少（早期10.7% ，晚期 29.4%， p = 0.039）。就病情的严重程度而言，伴有肝肾综合症的受体所占比例更大（肝肾综合症35.7% ，无肝肾综合症16.3%，p = 0.016），终末期肝病模型（MELD）的评分也更高（肝肾综合症34，无肝肾综合症26， p = 0.007）。移植特征相似。早期受体住院死亡率更高（早期6/28 ，晚期4/160，p = 0.001）。在紧急情况下进行的移植并不会造成住院死亡率的升高（紧急情况5/91，非紧急情况5/97，p = 0.917）。肝细胞癌移植受体没有一例住院死亡事件发生(0/50，10/138, p = 0.065)。通过单变量分析法可以发现，肝细胞癌的出现、早期移植均和生存率成反比。多变量分析证明了这一点，分析表明，早期(相对风险指数 2.824，p = 0.015)和肝细胞癌(相对风险指数2.897， p = 0.005)是总生存率的消极因素。

　　1年、3年和5年的总生存率分别为92.5%、86.3%和82.3%。当包括住院死亡和肝细胞癌移植的受体时，1年、3年和5年的总生存率就分别变成了97.6%、95.3%和 95.3%。肝细胞癌受体（50例）和符合米兰标准的受体的1年、3年和5年的总生存率分别为98.0%、80.5%、63.4%和97.1%、 85.0%、67.6%。

结论：该手术使患者5年生存率升高，特别是在可以避免住院死亡率的情况下。而随着技术的成熟以及仔细挑选肝细胞癌复发机会小的受体，住院死亡率就可以避免。

A Decade of Right Liver Adult-to-Adult Live Donor Liver Transplantation: Mid-Term Ootcomes
See Ching Chan, Barbara Chik, Chi Leung Liu, Chung Mau Lo, Sheung Tat Fan. Hepato Biliary Pancreatic Surgery, Dep. of Surgery, University of Hong Kong Medical Center, Hong Kong, Hong Kong

Introduction: Right liver adult-to-adult live donor liver transplantation debuted a decade ago is now due for mid-term outcomes appraisal.

Patients and methods: Consecutive liver transplant cases with a minimum follow-up of 2 years in Queen Mary Hospital, the University of Hong Kong from May 1996 to December 2004 were included (N=188). The data including recipient and graft characteristics were collected prospectively and were analyzed retrospectively. From 1996 to 2000, fewer than 30 cases per year were determined early era.

Results: This series had a median followup of 48 months. The early era included 28 cases and the latter era 160 cases. Recipients of the early era were slightly younger (42 yr vs. 48 yr, p = 0.002) and fewer of them suffered from hepatocellular carcinoma (HCC) (10.7% vs. 29.4%, p = 0.039). Disease severity was worse as reflected by a higher proportion of recipients with hepatorenal syndrome (35.7% vs. 16.3%, p = 0.016), and higher Model of End-stage Liver Disease scores (34 vs. 26, p = 0.007). Graft characteristics were similar. The recipients of the early era had higher hospital mortalities (6/28 vs. 4/160, p = 0.001). Transplantation in the high urgency situation did not result in higher hospital mortality (5/91 vs. 5/97, p = 0.917). None of the recipients transplanted for HCC had hospital mortality (0/50 vs. 10/138, p = 0.065). On univariate analysis, the presence of HCC and transplantation in the early era were of adverse factors for survival. This was verified by a multivariate analysis which indicated that early era (RR = 2.824, p = 0.015) and HCC (RR = 2.897, p = 0.005) were factors adversely affecting overall survival.

The 1-, 3-, and 5-year overall survivals were 92.5%, 86.3%, and 82.3%, respectively. When recipients with hospital mortality and transplanted for HCC were excluded, the 1-, 3-, and 5-year overall survivals became 97.6%, 95.3%, and 95.3%, respectively. Recipients with HCC (n = 50) and only those who were within the Milan criteria (n = 34) had 1-, 3-, and 5-year survivals of 98.0%, 80.5%, and 63.4%; and 97.1%, 85.0%, and, 67.6%, respectively.

Conclusion: This operation resulted in predictably high 5-year survival in particular when hospital mortality could be avoided after maturation of techniques and careful case selection of recipients with a low chance of recurrence from HCC.

[责任编辑:刘聪]