[临床肝移植​​二十年回顾]。

StephenW

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Mar;31(3):269-280. doi: 10.3760/cma.j.issn.2095-4352.2019.03.004.
[A twenty-year review of clinical liver transplantation].
[Article in Chinese]
Shen Z1, Gu C1, Zheng H1, Pan C1, Deng Y1, Du H2, Zhu Z3, Liu Y1, Sun L3, Liu Z4, Jiang W1, Zhang Y1, Gao W1, Cai J1, Zhang J1, Shen W5, Tang Y6, Li Y1, Zhang W1, Song H1, Wang Z7, Zhang Y8, Yu L1, Teng D1, Guo Q1.
Author information

1
    Organ Transplantation Center, Tianjin First Center Hospital, Tianjin Clinical Medical Research Center for Organ Transplantation, Key Laboratory of National Health Commission for Critical Care and Emergency Medicine, Key Laboratory of Chinese Academy of Medical Sciences for Organ Transplantation, Tianjin Key Laboratory for Organ Transplantation, Tianjin 300192, China.
2
    Department of Anesthesiology, Tianjin First Center Hospital, Tianjin 300192, China.
3
    Organ Transplantation Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
4
    Department of Hepatobiliary Surgery, the Fifth Medical Center of PLA General Hospital, Organ Transplantation Center, Beijing 100039, China.
5
    Department of Radiology, Tianjin First Center Hospital, Tianjin 300192, China.
6
    Department of Ultrasonography, Tianjin First Center Hospital, Tianjin 300192, China.
7
    Department of Pathology, Tianjin First Center Hospital, Tianjin 300192, China.
8
    Department of Pharmacy, Tianjin First Center Hospital, Tianjin 300192, China. Corresponding author: Shen Zhongyang, Email: [email protected].

Abstract
OBJECTIVE:

To review the development of adult and pediatric liver transplantation in Tianjin First Center Hospital, and to enhance academic exchanges, improve technological innovation, and jointly promote the progress and maturity in the field of liver transplantation.
METHODS:

The development of liver transplantation in Tianjin First Center Hospital was analyzed. The clinical data of adult and pediatric liver transplantation from September 1998 to September 2018 were collected. The important events and technological innovation achievements of liver transplantation during the 20 years were summarized.
RESULTS:

The first clinical liver transplantation was attempted in Tianjin First Central Hospital in April 1980. The first long-term survival adult liver transplantation in China was completed in 1994 (11 years survival after the operation). The specialized team of liver transplantation was formally established in September 1998. The 20-year clinical exploration and progress reflected the characteristics of era changes and technological innovation during the rapid development of liver transplantation in China. Our center performed liver re-transplantation in January 1999, reduced-size pediatric liver transplantation in August 2000. In May 2001, we organized the formulation for the preventive and treatment plan for hepatitis B recurrence after liver transplantation. We performed combined liver and kidney transplantation in July 2002, split liver transplantation (SLT) in April 2004, the first domino liver transplantation (DLT) in August 2005. Pediatric living donor liver transplantation (LDLT) was initiated in October 2006, adult LDLT was carried out in August 2007. In September 2007, the first living donor combined liver and kidney transplantation from the same donor in Asia was performed. The first domino+living donor double grafts liver transplantation in the world was performed in January 2009. In March 2011, we performed laparoscopically assisted right hepatic lobe liver transplantation (LDLT) with middle hepatic vein. In May 2014, living donor laparoscopic left lateral lobe procurement was successfully established. In April 2016, simultaneous liver, pancreas and kidney multi-organ transplantation was completed. Domino donor-auxiliary liver transplantation was performed in February 2017. In December 2017, extracorporeal membrane oxygenation (ECMO)-supported liver transplantation in a patient with severe pulmonary hypertension was successfully completed. Liver transplantation combined with partial splenectomy was established in April 2018. Cross-domino liver transplantation (hypersensitive kidney transplantation with auxiliary liver transplantation+pediatric liver transplantation) was performed in May 2018. During the 20 years, the team has performed or assisted other centers in Beijing, Shanghai, Guangzhou and Shenzhen to carry out more than 10 000 cases of liver transplantations. A total of 7 043 cases of various types of liver transplantation were performed in the single center of the hospital (6 005 adult liver transplantations and 1 038 pediatric liver transplantations). Concerning adult liver transplantation, the cumulative 1-year, 3-year and 5-year survival rate from September 1998 to March 2003 were 83.1%, 73.0% and 69.0%, from April 2003 to March 2009 were 85.3%, 76.2% and 72.1% and from April 2009 to September 2018 were 87.5%, 79.2% and 75.1%, respectively. The cumulative 1-year, 3-year and 5-year survival rate for pediatric liver transplantation were 93.5%, 92.2% and 90.2%, respectively. The nucleoside (acid) analogue combined with low dose hepatitis B immunoglobulin (HBIG) was developed to prevent the recurrence of hepatitis B after liver transplantation, this plan has reduced the recurrence rate of hepatitis B and the 5-year re-infection rate of hepatitis B virus (HBV) after liver transplantation significantly. The risk assessment system for tumor recurrence after liver transplantation was established and individual treatment method was established based on this assessment system. Continuous exploration and improvement of liver transplantation for liver cancer, liver re-transplantation, liver transplantation with portal vein thrombosis, SLT, DLT and multi-organ combined transplantation have significantly improved the clinical efficacy of patients and the post-operative survival rate.
CONCLUSIONS:

The liver transplantation team of Tianjin First Center Hospital has carried out a scientific and technological exploration on the key problems and technical difficulties of clinical liver transplantation. This work strongly has initiated and promoted the rapid development of liver transplantation in China. The restrictive barrier of hepatitis B recurrence after liver transplantation has been overcome. The risk prevention and control system of tumor recurrence after liver transplantation has been established. A series of innovative achievements that can be popularized have been achieved in the field of complex liver transplantation and expansion of donor liver source. The iterative progress and sustainable development of liver transplantation have been realized.

PMID:
    30914085
DOI:
    10.3760/cma.j.issn.2095-4352.2019.03.004

StephenW

中华卫中兵基础医学。 2019年3月; 31（3）：269-280。 doi：10.3760 / cma.j.issn.2095-4352.2019.03.004。
[临床肝移植​​二十年回顾]。
[中文]
Shen Z1，Gu C1，Zheng H1，Pan C1，Deng Y1，Du H2，Zhu Z3，Liu Y1，Sun L3，Liu Z4，Jiang W1，​​Zhang Y1，Gao W1，Cai J1，Zhang J1，Shen W5，Tang Y6 ，Li Y1，Zhang W1，​​Song H1，Wang Z7，Zhang Y8，Yu L1，Teng D1，Guo Q1。
作者信息

1
    器官移植中心，天津市第一中心医院，天津市器官移植临床医学研究中心，国家重症监护与急救医学重点实验室，中国医学科学院器官移植重点实验室，天津市器官移植重点实验室，天津300192
2
    天津市第一中心医院麻醉科，天津300192
3
    首都医科大学附属北京友谊医院器官移植中心，北京100050
4
    中国人民解放军总医院第五医疗中心肝胆外科，器官移植中心，北京100039
五
    天津市第一中心医院放射科，天津300192
6
    天津市第一中心医院超声科，天津300192
7
    天津市第一中心医院病理科，天津300192
8
    天津市第一中心医院药剂科，天津300192通讯作者：沉中阳，Email：[email protected]。

抽象
目的：

回顾天津市第一中心医院成人和小儿肝移植的发展，加强学术交流，加强技术创新，共同推动肝移植领域的进步和成熟。
方法：

分析了天津市第一中心医院肝移植的发展情况。收集1998年9月至2018年9月成人和小儿肝移植的临床资料。总结了20年来肝移植的重要事件和技术创新成果。
结果：

首次临床肝移植​​于1980年4月在天津市第一中心医院进行了试验。中国首例长期存活的成人肝移植于1994年完成（术后存活11年）。肝移植专业团队于1998年9月正式成立.20年的临床探索和进展反映了中国肝移植快速发展过程中时代变迁和技术创新的特点。我们的中心于1999年1月进行了肝脏再移植，2000年8月进行了小规模的小儿肝移植。2001年5月，我们组织了肝移植术后乙型肝炎复发的预防和治疗计划。我们于2002年7月进行了肝肾联合移植，2004年4月进行了肝移植（SLT），2005年8月首次进行了多米诺肝移植（DLT）。2006年10月开始了儿童活体肝移植（LDLT），成人LDLT 2007年8月进行了第一次活体供体联合来自亚洲同一捐赠者的肝脏和肾脏移植。世界上第一个多米诺骨牌+活体肝移植肝移植于2009年1月进行。2011年3月，我们进行了腹腔镜辅助右肝叶肝移植（LDLT）和肝中静脉。 2014年5月，成功建立了活体腹腔镜左侧外侧叶采购。 2016年4月，同时进行了肝脏，胰腺和肾脏多器官移植。 2017年2月进行了多米诺供体辅助肝移植。2017年12月，成功完成了体外膜肺氧合（ECMO）支持的肝移植治疗严重肺动脉高压患者。 2018年4月建立肝移植联合部分脾切除术。2018年5月进行了多支肝移植（辅助肝移植过敏肾移植+小儿肝移植）。在20年期间，该团队已经开展或协助其他中心北京，上海，广州和深圳开展了1万多例肝移植手术。在医院的单中心共进行了7 043例各种类型的肝移植（6 005例成人肝移植和1 038例小儿肝移植）。关于成人肝移植，从1998年9月到2003年3月，累计1年，3年和5年生存率分别为83.1％，73.0％和69.0％，从2003年4月到2009年3月分别为85.3％，76.2％和72.1％ 2009年4月至2018年9月的百分比分别为87.5％，79.2％和75.1％。小儿肝移植累积1年，3年和5年生存率分别为93.5％，92.2％和90.2％。开发了核苷（酸）类似物与低剂量乙型肝炎免疫球蛋白（HBIG）联合用于预防肝移植后乙型肝炎的复发，该计划降低了乙型肝炎的复发率和5年的肝炎再感染率肝移植后B病毒（HBV）明显增多。建立肝移植术后肿瘤复发风险评估系统，并在此评估系统的基础上建立个体化治疗方法。肝癌肝移植，肝再移植，门静脉血栓形成肝移植，SLT，DLT和多器官联合移植的不断探索和改进，显着提高了患者的临床疗效和术后生存率。
结论：

天津市第一中心医院肝移植队对临床肝移植​​的关键问题和技术难点进行了科学技术探索。这项工作有力地促进和促进了中国肝移植的快速发展。已经克服了肝移植后乙型肝炎复发的限制性障碍。建立了肝移植术后肿瘤复发的风险防控体系。在复杂肝移植和扩大供肝源方面，已经取得了一系列可以推广的创新成果。实现了肝移植的迭代进步和可持续发展。

结论：
    30914085
DOI：
    10.3760 / cma.j.issn.2095-4352.2019.03.004