影响DCD供肝质量的多因素分析
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摘要
目的分析影响心脏死亡器官捐献(DCD)供肝质量的相关因素。方法回顾性分析67例青岛大学附属医院于2014年7月-2017年9月完成的器官捐献并于本院实施肝移植供者的临床资料,供者资料作为自变量,包括年龄、性别、原发病、救治时间、高血压、糖尿病、吸烟、饮酒、体重指数(BMI)、脂肪肝程度、白蛋白、血清钠、血糖、动脉血氧分压(PaO_2)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST),并收集相应受者术后15天肝功能水平,包括:AST、ALT、总胆红素(TBiL)、直接胆红素(DBi L),上述自变量分别与因变量作Spearman两两相关分析,筛选出显著性相关的变量进行多重线性回归分析,得出回归方程并进行方差分析,评估供肝质量的影响因素。结果年龄、高血压、吸烟、原发病与肝移植术后15天的TBi L显著性相关(r=0.227、2.7、0.338、0.288,均P<0.05),年龄、吸烟与肝移植术后15天DBiL显著性相关(r=2.78、0.26,均P<0.05)。拟合的回归模型:log_(10)TBi L=1.732+0.006×年龄+0.123×(1或0,1表示脑外伤,0表示脑出血)+0.151×(1或0,1表示吸烟,0表示不吸烟),调整R~2=0.224(F=6.962,P<0.01),log_(10)DBi L=1.795+0.011×年龄+0.17×(1或0,1表示吸烟,0表示不吸烟),调整R~2=0.186(F=8.416,P=0.001)。结论供者年龄、吸烟、原发病是影响肝移植术后早期移植肝肝功能异常的危险因素,脑外伤供肝患者肝移植术后总胆红素水平与脑出血供肝患者相比恢复较慢。
Objective To analyze factors related to the quality of donor livers donated after cardiac death(DCD).Methods 67 patients who received liver transplantation in the Affiliated Hospital of Qingdao University between July 2014 and September 2017 were studied.Donor information,including age,sex,primary disease,treatment time,hypertension,diabetes,smoking,drinking,body mass index(BMI),level of the fatty liver disease,albumin,serum sodium,blood glucose,arterial oxygen pressure(Pa O_2),alanine aminotransferase(ALT),aspartate aminotransferase(AST),as well as liver function of recipients,including AST,ALT,total bilirubin(TBi L)and direct bilirubin(DBi L),were analyzed by Spearman correlation test.Factors correlated with the dependent variant were selectedand further analyzed by a multiple linear regression analysis.A regression model was establised by influence factors,to evaluate the quality of donor livers.Results Age,hypertension,smoking,and primary disease were significantly associated with TBi L on day 15 after liver transplantation(r=0.227,2.7,0.338,0.288,all P<0.05),age and smoking were significantly associated with DBi L on day 15 after liver transplantation(r=2.78,0.26,both P<0.05).The Fitting regression models were log_(10)TBi L=1.732+0.006×Age+0.123×(1 or 0,1 for traumatic brain injury,0 for intracerebral hemorrhage)+0.151×(1 or 0,1 for smoking,0 for no smoking),adjusted R~2=0.224(F=6.962,P<0.01)and log_(10)DBi L=1.795+0.011×Age+0.17×(1 or 0,1 for smoking,0 for no smoking),adjusted R~2=0.186(F=8.416,P=0.001).Conclusion Hypertension,age,smoking,primary disease are the risk factors that affect the postoperative liver function in the early stage of liver transplantation,and the recovery of total bilirubin level after liver transplantation in patients with brain trauma is slower than that of patients with cerebral hemorrhage.
Objective To analyze factors related to the quality of donor livers donated after cardiac death(DCD).Methods 67 patients who received liver transplantation in the Affiliated Hospital of Qingdao University between July 2014 and September 2017 were studied.Donor information,including age,sex,primary disease,treatment time,hypertension,diabetes,smoking,drinking,body mass index(BMI),level of the fatty liver disease,albumin,serum sodium,blood glucose,arterial oxygen pressure(Pa O_2),alanine aminotransferase(ALT),aspartate aminotransferase(AST),as well as liver function of recipients,including AST,ALT,total bilirubin(TBi L)and direct bilirubin(DBi L),were analyzed by Spearman correlation test.Factors correlated with the dependent variant were selectedand further analyzed by a multiple linear regression analysis.A regression model was establised by influence factors,to evaluate the quality of donor livers.Results Age,hypertension,smoking,and primary disease were significantly associated with TBi L on day 15 after liver transplantation(r=0.227,2.7,0.338,0.288,all P<0.05),age and smoking were significantly associated with DBi L on day 15 after liver transplantation(r=2.78,0.26,both P<0.05).The Fitting regression models were log_(10)TBi L=1.732+0.006×Age+0.123×(1 or 0,1 for traumatic brain injury,0 for intracerebral hemorrhage)+0.151×(1 or 0,1 for smoking,0 for no smoking),adjusted R~2=0.224(F=6.962,P<0.01)and log_(10)DBi L=1.795+0.011×Age+0.17×(1 or 0,1 for smoking,0 for no smoking),adjusted R~2=0.186(F=8.416,P=0.001).Conclusion Hypertension,age,smoking,primary disease are the risk factors that affect the postoperative liver function in the early stage of liver transplantation,and the recovery of total bilirubin level after liver transplantation in patients with brain trauma is slower than that of patients with cerebral hemorrhage.
引文
[1]李静,杨怡萍,王兰英.肝移植患者术前访视的效果分析[J].中国中西医结合急救杂志,2016,23(3):318-319.
[2]谢双双,沈文.活体肝移植供体术前影像评估方法研究进展[J/CD].实用器官移植电子杂志,2016,4(4):248-252.
[3]Kalisvaart M,de Haan JE,Polak WG,et al.Comparison of postoperative outcomes between donation after circulatory death and donation after brain death liver transplantation using the comprehensive complication index[J].Ann Surg,2017,266(5):772-778.
[4]Hrydziuszko O,Perera MT,Laing R,et al.Mass spectrometry based metabolomics comparison of liver grafts from donors after circulatory death(DCD)and donors after brain death(DBD)used in human orthotopic liver transplantation[J].Plos One,2016,11(11):e0165884.
[5]Liu X,Wang B,Zhang X,et al.Liver transplantation using donation after brain and cardiac death:a single-center experience in China[J].Transplantation Proceedings,2016,48(6):1879-1886.
[6]Scalea JR,Redfield RR,Foley DP.Liver transplant outcomes using ideal donation after circulatory death livers are superior to using older donation after brain death donor livers[J].Liver Transpl,2016,22(9):1197-1204.
[7]王峪,刘懿禾,郑卫萍,等.成人原位肝移植术后早期感染相关危险因素分析[J].中华危重病急救医学,2006,18(7):406-408.
[8]Abt PL,Praestgaard J,West S,et al.Donor hemodynamic profile presages graft survival in donation after cardiac death liver transplantation[J].Liver Transpl,2014,20(2):165-172.
[9]Liu Q,Nassar A,Farias K,et al.Sanguineous normothermic machine perfusion improves hemodynamics and biliary epithelial regeneration in donation after cardiac death porcine livers[J].Liver Transpl,2014,20(8):987-999.
[10]Belzberg H,Shoemaker WC,Wo CC,et al.Hemodynamic and oxygen transport patterns after head trauma and brain death:implications for management of the organ donor[J].J Trauma,2007,63(5):1032-1042.
[11]Silva IA,Correia CJ,Simas R,et al.Inhibition of autonomic storm by epidural anesthesia does not influence cardiac inflammatory response after brain death in rats[J].Transplant Proc,2012,44(7):2213-2218.
[12]Peralta C,Jiménez-Castro MB,Gracia-Sancho J.Hepatic ischemia and reperfusion injury:effects on the liver sinusoidal milieu[J].J Hepatol,2013,59(5):1094-1106.
[13]Kalisvaart M,de Haan JE,Hesselink DA,et al.The severity of hepatic ischaemia-reperfusion injury is associated with acute kidney injury following donation after brain death liver transplantation[J].Transpl Int,2017,30(7):660-669.
[14]傅斌生,易述红,唐晖,等.公民逝世后器官捐献供肝质量评估和维护的体会[J].器官移植,2016,7(3):215-218.
[15]H Ledinh,N Meurisse,MH Delbouille,et al.Contribution of donors after cardiac death to the deceased donor pool:2002 to2009 University of Liege experience[J].Transplant Proc,2010,42(10):4369-4372.
[16]王小平,韩明,焦兴元,等.脑出血和脑外伤DCD供肝移植疗效分析[C].浙江:浙江省科学技术协会,2013.
[17]郑飞波,蒋文涛,张骊,等.脂肪变性供肝对成人肝移植早期预后的影响[J].中华普通外科杂志,2016,31(3):201-203.
[18]曹海洋,吴晓峰,林栋栋.脂肪肝供体临床应用的研究进展[J].临床肝胆病杂志,2015,31(7):1140-1143.
[19]Selzner N,Selzner M,Jochum W,et al.Mouse livers with macrosteatosis are more susceptible to normothermic ischemic injury than those with microsteatosis[J].J Hepatology,2006,44(4):694-701.
[20]Chui AK,Haghighi K,Painter D,et al.Donor fatty(steatotic)liver allografts in orthotopic liver transplantation[J].Transplant Proc,1998,30(7):3286-3287.
[21]Salizzoni M,Franchello A,Zamboni F,et al.Marginal grafts:finding the correct treatment for fatty livers[J].Transpl Int,2003,16(7):486-493.
[22]Corradini SG,Elisei W,De Marco R,et al.Preharvest donor hyperoxia predicts good early graft function and longer graft survival after liver transplantation[J].Liver Transpl,2005,11(2):140-151.
[23]Afonso RC,Saad WA,Parra OM,et al.Impact of steatotic grafts on initial function and prognosis after liver transplantation[J].Transplant Proc,2004,36(4):909-911.--
[2]谢双双,沈文.活体肝移植供体术前影像评估方法研究进展[J/CD].实用器官移植电子杂志,2016,4(4):248-252.
[3]Kalisvaart M,de Haan JE,Polak WG,et al.Comparison of postoperative outcomes between donation after circulatory death and donation after brain death liver transplantation using the comprehensive complication index[J].Ann Surg,2017,266(5):772-778.
[4]Hrydziuszko O,Perera MT,Laing R,et al.Mass spectrometry based metabolomics comparison of liver grafts from donors after circulatory death(DCD)and donors after brain death(DBD)used in human orthotopic liver transplantation[J].Plos One,2016,11(11):e0165884.
[5]Liu X,Wang B,Zhang X,et al.Liver transplantation using donation after brain and cardiac death:a single-center experience in China[J].Transplantation Proceedings,2016,48(6):1879-1886.
[6]Scalea JR,Redfield RR,Foley DP.Liver transplant outcomes using ideal donation after circulatory death livers are superior to using older donation after brain death donor livers[J].Liver Transpl,2016,22(9):1197-1204.
[7]王峪,刘懿禾,郑卫萍,等.成人原位肝移植术后早期感染相关危险因素分析[J].中华危重病急救医学,2006,18(7):406-408.
[8]Abt PL,Praestgaard J,West S,et al.Donor hemodynamic profile presages graft survival in donation after cardiac death liver transplantation[J].Liver Transpl,2014,20(2):165-172.
[9]Liu Q,Nassar A,Farias K,et al.Sanguineous normothermic machine perfusion improves hemodynamics and biliary epithelial regeneration in donation after cardiac death porcine livers[J].Liver Transpl,2014,20(8):987-999.
[10]Belzberg H,Shoemaker WC,Wo CC,et al.Hemodynamic and oxygen transport patterns after head trauma and brain death:implications for management of the organ donor[J].J Trauma,2007,63(5):1032-1042.
[11]Silva IA,Correia CJ,Simas R,et al.Inhibition of autonomic storm by epidural anesthesia does not influence cardiac inflammatory response after brain death in rats[J].Transplant Proc,2012,44(7):2213-2218.
[12]Peralta C,Jiménez-Castro MB,Gracia-Sancho J.Hepatic ischemia and reperfusion injury:effects on the liver sinusoidal milieu[J].J Hepatol,2013,59(5):1094-1106.
[13]Kalisvaart M,de Haan JE,Hesselink DA,et al.The severity of hepatic ischaemia-reperfusion injury is associated with acute kidney injury following donation after brain death liver transplantation[J].Transpl Int,2017,30(7):660-669.
[14]傅斌生,易述红,唐晖,等.公民逝世后器官捐献供肝质量评估和维护的体会[J].器官移植,2016,7(3):215-218.
[15]H Ledinh,N Meurisse,MH Delbouille,et al.Contribution of donors after cardiac death to the deceased donor pool:2002 to2009 University of Liege experience[J].Transplant Proc,2010,42(10):4369-4372.
[16]王小平,韩明,焦兴元,等.脑出血和脑外伤DCD供肝移植疗效分析[C].浙江:浙江省科学技术协会,2013.
[17]郑飞波,蒋文涛,张骊,等.脂肪变性供肝对成人肝移植早期预后的影响[J].中华普通外科杂志,2016,31(3):201-203.
[18]曹海洋,吴晓峰,林栋栋.脂肪肝供体临床应用的研究进展[J].临床肝胆病杂志,2015,31(7):1140-1143.
[19]Selzner N,Selzner M,Jochum W,et al.Mouse livers with macrosteatosis are more susceptible to normothermic ischemic injury than those with microsteatosis[J].J Hepatology,2006,44(4):694-701.
[20]Chui AK,Haghighi K,Painter D,et al.Donor fatty(steatotic)liver allografts in orthotopic liver transplantation[J].Transplant Proc,1998,30(7):3286-3287.
[21]Salizzoni M,Franchello A,Zamboni F,et al.Marginal grafts:finding the correct treatment for fatty livers[J].Transpl Int,2003,16(7):486-493.
[22]Corradini SG,Elisei W,De Marco R,et al.Preharvest donor hyperoxia predicts good early graft function and longer graft survival after liver transplantation[J].Liver Transpl,2005,11(2):140-151.
[23]Afonso RC,Saad WA,Parra OM,et al.Impact of steatotic grafts on initial function and prognosis after liver transplantation[J].Transplant Proc,2004,36(4):909-911.--
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