The Report And Analysis About34Liver Transplantation Cases In One Single Centre

Objective To analysis the stations during the perioperative period and the follow-up after the operation about the32patients, the observation period was from January in1998to February in2012and two of these32patients underwent repeated liver transplantation. The risk factors which may affect the survival after the operation were investigated in order to optimize the treatment. Method Retrospectively analysis the dates during the perioperative period and the follow-up after the operation about the32patients, the observation period was from January in1998to February in2012and two of these32patients underwent repeated liver transplantation. The first liver operation was conducted in the general surgery department of the First Affiliated Hospital in1998, but the organ transplantation department was established in the July of2005, and the fixed team was formed in the July of2006. Then, under the help of some hospitals (Mali Hospital in Hong Kong, Renji Hospital in Shang Hai, the Third Affiliated Hospital of Zhong Shan University in Guang Zhou), we formed the nature experiences about the administration and the treatment during the perioperative period. We divided the patients into2groups according two consequent time periods:group A (n=17):from January in1998to December in2006; group B (n=17):from January in2007to March in2012.①the dates of preoperation:gender, age, the first diagnose, the score of the MELD, the score of the Child, HBV-DNA, weather the anti-virus treatment was conducted, the serious complication, renal dialysis, artificial liver, history of operation, weather the operation was emergency. The dates during the operation:anhepatic phase, the time of the operation (min), the amount of the blood transfusion (ml), weather there was a T-canal, the amount of urine (ml). The dates of post-operation:anti-rejection in the early stage (three drugs or two drugs), acu-rejection in the early stage, the serious complication in the early stage and the late period;23observation indexes were enter into the SPSS10.0. First, different test were conducted in the two groups separately, then, Logistic-analysis was conducted to analysis the mortality rate in the hospital, finally, the Cox-analysis was conducted about all these dates in23indexes. Investigate the risk factors which may affect the survival after the operation.②on the basis conditions of the follow-up about the2groups, Kaplan-Meier survival-analysis was conducted to draw the cumulate survival curve, and get the cumulate survival rate. Results There were32patients underwent liver transplantation from January in1998to February in2012and two of these32patients underwent repeated liver transplantation. We divided the patients into2groups:group A:from January in1998to December in2006(n=17male/female=16/1, the mean age:42.82±13.78); group B (n=17male/female＝4/3the mean age:44.00±8.96):from January in2007to February in2012. The blood type (A-type14cases, B-type9cases, O-type8cases, AB-type3cases), all were RhD (+). The blood type of the donator and the acceptor were the same. The first diagnose of the group A:liver cancer:4cases, the decompensation period of the HBV:9cases, other type of liver disease (non-function of the transplanted liver, acute-hepatic injury associated with the drugs, chronic alcohol associated lived disease, schistosome-associated liver disease,1case for each type):4cases. The first diagnose of the group B:liver cancer:6cases(35.29%), the decompensation period of the HBV:8cases(47.06), other type of liver disease (non-function of the transplanted liver:3cases, autoimmune liver disease:1cases). The mean score of the MELD about two groups: range (10-36), mean:22.06±9.03, range (5-26) mean:12.12±6.66. The mean score of the Child about two groups:range (6-14.8), mean:10.00±2, range (5～12), mean: 21.65±2.50. The mean dates of AFP about two groups:range (1.5～1000ng/ml), mean:72.69±240.69ng/ml, range (0-1169ng/ml), mean:74.66±282.24ng/ml. There were11patients (64.71%) in the group A whose HBV-DNA>1000copies/ml and6patients whose HBV-DNA<1000copies/ml by contrast, in the group B, these index were5(29.41%) and12(70.59%) respectively. Anti-virus treatment:5patients (29.41%);4patients (23.53%). Serious complication:9patients (52.94%);9patients (52.94%). Renal dialysis before the operation:2patients (11.76%);0patients (0%). Artificial liver:1patients (5.88%);3patients (17.65%). History of operation:4patients (23.53%);8patients (47.06%). Weather the operation was emergency:5patients (29.41%);3patients (17.65%). The different test was conducted about the pro-operation index and there were statistical significance about the score of MELD and HBV-DNA. An hepatic phase:range (60-450min), mean93.94±94.16; range (40-120min), mean63.29±18.65min.The time of the operation (min):range (7.00-22.00h), mean10.21±3.35h; range (5.50-13.00h), mean8.18±2.17h. The amount of the blood transfusion (ml): range (400-4000ml), mean1976.47±1307.44ml; range (0.00-3600ml), mean917.65±938.24ml. Weather there was a T-canal:2patients (11.76%),3patients (17.65%). The amount of urine (ml):range (800-12100ml), mean2002.94±2861.30ml; range(800-4500ml), mean1852.94±1026.59ml. The different test was conducted about these index and there were statistical significance about the the time of the operation (min), the amount of the blood transfusion (ml) p<0.05. The post-operation anti-rejection in the group A [three drugs:2patients (11.76%) or two drugs15patients (88.24%)], by contrast, in the group B [three drugs:5patients (29.41%) or two drugs12patients (70.59%)]. Acu-rejection in the early stage was frond in two groups [5patients(29.41%) in the group A and3patients(17.65%) in the group B]. Mortality rate in the hospital was35.29%in the group A (6patients) and5.88%in the group B(l patients). The serious complication rate in the early stage was58.83%in the group A (10patients) and35.29%in the group B (6patients). The serious complication rate in the late period was11.76%in the group A (2patients) and5.88%in the group B(1patients). The different test was conducted about these post-operation indexes and there was statistical significance about the mortality rate in the hospital (p<0.05). The Logistic regression analysis of the single factor was conducted about these23observation indexes, the result suggested that:the diagnose, properation renal dialysis, time of the operation, serious complications are the single factors which affect the minority in the hospital. The results of the multiple factor Cox regression analysis suggest that there was no statistic different between these factors, so there was no independent factors which affect the minority in hospital. According to the minority in the hospital and the condition about the follow-up, we used the Kaplan-Meier survival analysis method, the result suggested that in the group A, the accumulated survival rate was58.82%, and88.89%in the group B. For all the patients, the accumulated survival rate was70.46%. Conclusion There is statistic different among the1-year accumulated survival rate, the diagnose, the score of MELD, pro-operation renal dialysis, the time of the operation and the serious complication, which may affect the minority in the hospital. The advanced of operation skills and anesthesia may improve long-term survivors rate and reduce operation mortality rate. The FK506single drug for rejection is safety and benefit for delaying recurrence of HCC and HBV drug resistance.