【摘要】 目的：评价大样本肝移植病人长期生存情况和分析影响移植疗效的动静态因素。背景回顾：自１９８３年以来肝移植被接受为治疗终末期肝病的主要选择之一，随着免疫抑制剂的发展、手术技术的不断完善、取肝及保存方法的改进，生存期获不断延长。虽然报告影响近期生存因素的文章甚众，但分析影响长期生存因素者却不多见。方法：回顾性分析１９８１年２月至１９９８年４月连续施行的４０００例肝移植资料（随访至２０００年３月），并对移植时供、受体年龄、受体性别和诊断以及移植年份等因素进行比较；也统计了再移植率、再移植原因和死亡原因。结果：全组的总生存率为５９％，统计１８年生存率为４８％；小儿、女性和１９９０年以后接受移植的病人生存情况显著较好。以ＦＫ５０６为基础的免疫抑制剂使因急、慢性排斥反应而施行的再移植率显著下降。手术一年后，移植肝脏丧失功能病人死亡的曲线相对趋于平稳，疾病复发、恶性肿瘤和与年龄相关的并发症是移植物丧失功能的最主要因素。结论：随着年代的推移，病人和移植物的生存活情况获显著改善，由急性、慢性排斥反应所致的移植物失功已属十分罕见，与年龄相关和疾病相关的移植物失功，已构成肝移植患者长期生存的最大威胁。更多还原

【Abstract】 Objective:To evaluate the long-term survival outcomes of a large cohort of liver transplant recipients and to identify static and changing factors that influenced these outcomes over time. Liver transplantation has been accepted as a therapeutic option for patients with end-stage liver disease since 1983, with continual improvements in patient survival as a result of advances in immunosuppression and medical management, technical achievements, and improvements in procurement and preservation. Although many reports, including registry data, have delineated short-term factors that influence survival, few reports have examined factors that affect long-term survival after liver transplantation.Methods: Four thousand consecutive patients who underwent liver transplantation between February 1981 and April 1998 were included in this analysis and were followed up to March 2000. The effect of donor and recipient age at the time of transplantation, recipient gender, diagnosis, and year of transplantation were compared. Rates of retransplantation, causes of retransplantation, and cause of death were also examined.Results: The overall patient survival for the entire cohort was 59%; the actuarial 18-year survival was 48%. Patient survival was significantly better in children, in female recipients, and in patients who received transplants after 1990. The rates of retransplantation for acute or chronic rejection were significantly lower with tacrolimus-based immunosuppression. The risk of graft failure and death was relatively stable after the first year, with recurrence of disease, malignancies, and age- related complications being the major factors for loss.Conclusions:Significantly improved patient and graft survi- val has been observed over time, and graft loss from acute or chronic rejection has emerged as a rarity. Age-related and disease-related causes of graft loss represent the greatest threat to long-term survival.更多还原