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Liver retransplantation for ischemic-type biliary lesions after orthotopic liver transplantation: a clinical report of 66 cases |
Zhi-Jun Zhu, Wei Rao, Ji-San Sun, Jin-Zhen Cai, Yong-Lin Deng, Hong Zheng, Ya-Min Zhang, Wen-Tao Jiang, Jian-Jun Zhang, Wei Gao and Zhong-Yang Shen |
Tianjin, China
Author Affiliations: Department of Organ Transplantation, Transplant Center, Tianjin First Central Hospital, Tianjin 300192, China (Zhu ZJ, Rao W, Sun JS, Cai JZ, Deng YL, Zheng H, Zhang YM, Jiang WT, Zhang JJ, Gao W and Shen ZY)
Corresponding Author: Zhi-Jun Zhu, MD, Department of Organ Transplantation, Transplant Center, Tianjin First Central Hospital, Tianjin 300192, China (Tel: 85-22-23626893; Fax: 86-22-23626897; Email: Zhu-zhijun@medmail.com.cn) |
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Abstract BACKGROUND: Ischemic-type biliary lesions (ITBLs) play an extremely important role in influencing the long-term survival and quality of life of recipients after orthotopic liver transplantation (OLT). Some patients can be cured by interventional therapies, however others lose their grafts at last and receive liver retransplantation (re-OLT). The aim of this study was to analyze the data of 66 patients who had received re-OLT at our center because of ITBL and to discuss the treatment of ITBL after OLT.
METHODS: We retrospectively analyzed 66 re-OLT cases due to ITBL from September 2001 to February 2007 at our center. The Kaplan-Meier method and the Cox-Mantel test were used to identify factors associated with mortality for univariate analysis and multivariate analysis, respectively.
RESULTS: Fifty-five of 66 ITBL cases underwent interventional therapies before re-OLT. The actuarial survival at 1 month and 1 year for these patients was 83% and 74%, respectively. Prognostic factors for mortality in univariate analysis were model of end-stage liver disease score (MELD) >16.5 (χ2=5.856, P=0.016), cold ischemia time >8 hours (χ2=6.539, P=0.011), infections (χ2=5.550, P=0.018) and complications (χ2=12.168, P=0.002) after re-OLT. In the multivariate analysis (Cox regression), the risk factors independently associated with mortality were MELD score >16.5 (RR: 3.140; P=0.035), cold ischemia time >8.2 hours (RR: 0.192; P=0.016) and complications (RR: 3.896, P=0.003).
CONCLUSIONS: The incidence of ITBL in China is higher than in other countries. Based on our experience, MELD score, cold ischemia time and complications after re-OLT are risk factors independently associated with mortality in retransplanted ITBL patients.
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Cite this article: |
Zhu ZJ,
Rao W,
Sun JS,
et al.
Liver retransplantation for ischemic-type biliary lesions after orthotopic liver transplantation: a clinical report of 66 cases.
Hepatobiliary Pancreat Dis Int
2008;
7(5):
471-475. DOI:
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URL: |
http://dx.doi.org/ OR http://www.hbpdint.com/EN/Y2008/V7/I5/471 |
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