第三节肝移植的禁忌证和危险因素

第三节　肝移植的禁忌证和危险因素

　　一、禁忌证

　　如果病人合并有下列疾病，应视为手术禁忌证。

　　（1） 血清中人类免疫缺陷病毒（HIV）阳性。

　　（2） 肝外恶性肿瘤。

　　（3） 胆管癌。

　　（4） 严重的心肺疾病。

　　（5） 未控制的全身性感染。

　　（6） 其他脏器功能衰竭。

　　（7） 心理学方面的不适应。

　　二、危险因素

　　肝移植的主要危险因素包括：年龄偏大、肌营养不良、昏迷、腹水、活动性出血和既往有腹部手术史等。表3-1为Pittsburgh的术前评估表，可用来粗略预测肝移植术后病人的存活率。

表3-1 肝移植受体术前评估表

　　本表应用比分累计法，0-3分表示低危病人，如果等于或高于7分，意味着存在着比3分病人高1倍的危险性。单一的因素如术后出血等，与术后病人的存活率也明显相关。既往腹有手术史，特别是胆管手术史，将明显增加手术的难度。

　　参考文献

　　1.Feray C,Zignergo AL,Samuel D et al.Persistent hepatitis Bvirus infetion of mononuclear blood cells without concomitant infection.The liver transplantation model.Transplantation,1990,49:1155

　　2.Pemetris AJ ,Todo S, Van Thiel Dhet al.Evolution of hepatitis B virus liver disease after hepatic replacement.Practical and theoretical consideration.Am J Pathol,1990,137:667

　　3.O’Grady JG,Willians R.Liver transplantation for viral hepatitis .Br Med Bull.1990,46:481

　　4.Mazzaferro V,Regalia E,Montalto F et al.Risk of HBV reinfection afeter liver transplantation in HbsAg-positive cirrhosis.Primary hepatocellular carcinoma is not a predictor for HBV recurrence.Liver ,1996,16:117

　　5.Marsman WA,Wiesher RH,Batts KP et al.Fulminant hepatitis Bvirus:recurrence after liver transplantation in two patients also infected with hepatitis delta virus.Hepatology,1997,25:434

　　6.Hart J.Busuttil RW,Lewm KJ.Disease recurrence following liver transplantation.Am J Surg Pathol.1990,14(Suppl1):79

　　7.Martin P,Munoz SJ,DiBisceglia AM et al.Recurrence of hepatitis Cvirus infection after orthotopic liver transplantation.Hepatology,1991,13:719

　　8.Gane EJ,Portinann BC,Waoumov NV et al .Long-term outcome of hepatitis Cinfection after liver transplantation.N Engl Med,1996,334:815

　　9.Baber KH,Dalley G,Bahr MJ et al.Long-term outcome of hepatitis C virus infection after liver transplatation .Hepatology,1997,25 :202

　　10.Terrault NA,Zhou S,Combs Cet al.Prophylaxis in liver transplant recipient using a fixed dosing schedule of hepatitis Bimmunoglobulin.Hepatology,1996,24:1327

　　11.Van Thiel DH,Bonet H,Gavaler J et al ,Effect of alcohol use on allograft liver transplantation for alcoholic liver disease.Alcohol Chin Exp Res,1995,19:1151

　　12.Maddrey WC.Bone disease in patients with primary biliary cirrhosis.Prog Liver Dis,1990,9:537

　　13.Shapiro JM,Smith H,Schaffner F.Serum bilirubin: a prognostic factor in primary biliary cirrhosis.Gut,1979,20:137

　　14.Mentna G,Giostra E,Rubbia L et al .Follow-up and result of liver transplantation of primary biliary cirrhosis.Swiss Surg,1996,3:116

　　15.Knoop M,Bechstein Wo,Schrem H et al.Chinical significance of recurrent primary billiary cirrhosis after liver transplantation .Transpl Int,1996,9(Suppl 1):S115

　　16.Sternlieb I.Wilson’s disease:indication for liver transplantation.Hepatology,1984,4:155

　　17.Exquive CO,Marino IR,Fioravanti V et al.Liver transplantation formetabolic disease of the liver,Gastroenterol Clin N Am,1988,17:167

　　18. Ismail T,Angrisani L,Gunson BK et al,Primary hepatic malignancy:The role of liver transplantation,Br J Surg,1990,77:983

　　19.Hoofnagle JH,Carithevs RC Jr,Shapiro Cet al.Fulminant hepatic failure:summary of a workshop.Hepatology,1995,21:240

　　20.Williams R,Wendon J.Indication for orthotopic liver transplantation in fulminant liver failure.Hepatology,1994,20:1.

　　21.Ludwing J,LaRusso NF,Wiesner RH.The syndrome of primary sclerosing cholangitis.Prog Liver Dis,1990,9:555

　　22 .Rosen CB,Nagorney DM,Wiesner RH et al.Cholangiocarcinoma complicating primary sclerosing cholangitis .Ann Surg,1991,213:21

　　23.Olsson R,Panielsson ,A,Jarnerot G et al .Prevalence of primary sclerosing cholangitis in patients with ulcerative colitis.Gastroenterology,1991,11:1319

　　24.Higashi H,Yanaga K,Marsh JW et al.Development of colon cancer after transplantation for primary sclerosing cholangitis associated with ulcerative colitis.Hepatology,1990,11:477

　　25.Alayoglu M,Stratta RJ,Sollinger HW .Liner transplantation in infans and children.J Pediatr Surg,1989,24:70

　　26.Salerno F,Borroni G,Moser Pet al .Prognostic value of the galactose test in predicting survival of patients with cirrhosis evaluated for liver transplantation A prospective multicenter Italian study.AISF Group for the Study of Liver Transplantation.Association Italiana per lo Studio del Fegato.Hepatol.1996,25474