CAJ | 학술논문

目的：探讨肝移植治疗终末期自身免疫性肝病（AILD）的预后情况。方法回顾性分析1996年5月至2013年4月在第二军医大学附属长征医院实施原位肝移植术的48例终末期AILD受者的临床资料。计算受者的术后累积生存率，分析死亡病例的死因，了解术后排斥反应、病毒性肝炎新发感染及AILD复发情况。结果48例AILD受者中，存活38例，AILD受者术后5年累积生存率为76％。10例死亡受者的死亡原因包括多器官功能衰竭、移植肝衰竭、脓毒症、肺部感染、出血、肝动脉栓塞、肾衰竭。48例AILD受者中，肝移植术后发生急性排斥反应者9例（19％），有3例分别在术后1～2年内新发乙型肝炎病毒感染，有2例原发性胆汁性肝硬化受者于术后2年出现原发病复发，经积极治疗均长期生存。结论终末期AILD肝移植受者多数可获得长期生存，应重视肝移植术后早期免疫抑制方案的制定，预防感染及排斥反应和术后新发病毒性肝炎，及时发现原发病复发等问题。
목적：탐토간이식치료종말기자신면역성간병（AILD）적예후정황。방법회고성분석1996년5월지2013년4월재제이군의대학부속장정의원실시원위간이식술적48례종말기AILD수자적림상자료。계산수자적술후루적생존솔，분석사망병례적사인，료해술후배척반응、병독성간염신발감염급AILD복발정황。결과48례AILD수자중，존활38례，AILD수자술후5년루적생존솔위76％。10례사망수자적사망원인포괄다기관공능쇠갈、이식간쇠갈、농독증、폐부감염、출혈、간동맥전새、신쇠갈。48례AILD수자중，간이식술후발생급성배척반응자9례（19％），유3례분별재술후1～2년내신발을형간염병독감염，유2례원발성담즙성간경화수자우술후2년출현원발병복발，경적겁치료균장기생존。결론종말기AILD간이식수자다수가획득장기생존，응중시간이식술후조기면역억제방안적제정，예방감염급배척반응화술후신발병독성간염，급시발현원발병복발등문제。
Objective To investigate the prognosis of patients underwent liver transplantation (LT) for end-stage autoimmune liver disease (AILD). Methods Clinical data of 48 patients with end-stage AILD undergoing LT from May 1996 to April 2013 in Affiliated Changzheng Hospital of the Second Military Medical University were analyzed retrospectively. The postoperative cumulative survival rates of the recipients were calculated,and the cause of death was analyzed. The postoperative rejections,new-onset viral hepatitis and AILD recurrence were analyzed. Results In 48 AILD recipients,38 cases survived and the postoperative 5-year cumulative survival rate was 76%. Causes of death for the 10 dead cases were multiple organ failure, liver graft failure,sepsis,pulmonary infection,hemorrhage,hepatic artery embolization and renal failure. In 48 AILD recipients,9 cases (19%) suffered acute rejection after operation,3 cases suffered new-onset hepatitis B infection in 1-2 years after operation,2 recipients suffered primary disease (primary biliary cirrhosis)recurrence 2 years after operation and all survived for a long term after positive treatments.Conclusions Most liver transplant recipients with end-stage AILD can obtain a long-term survival. Attentions should be paid on the immunosuppressive regimens in early period after LT,prevention of infection,rejection and postoperative new-onset viral hepatitis,timely diagnosis of primary disease recurrence.