公民逝世器官捐献肝移植术后早期肝功能不全危险因素分析
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摘要
目的公民逝世后器官捐献肝移植术后早期肝功能不全发生率高,影响患者预后。文中分析公民逝世后器官捐献肝移植术后早期肝功能不全的发生情况,探讨早期肝功能不全的危险因素。方法回顾性分析2015年1月至2017年12月间联勤保障部队第900医院(原福州总医院)86例行肝移植供、受体资料。采用倾向评分配比法对肝移植受体术前及术中情况进行配比配对,在17项供体相关变量中分析影响EAD的危险因素。结果 79例肝移植患者术后早期肝功能不全的发生率为32.9%。单因素分析结果显示,供体体重指数、热缺血时间及冷缺血不同诊断结果患者组间差异有统计学意义(P<0.05);多因素logistic回归分析结果显示,供体血清钠、谷丙转氨酶及热缺血时间组间差异有统计学意义(P<0.05);ROC曲线分析结果显示,供体血清钠及热缺血时间可准确预测术后早期肝功能不全的最佳临界值分别为152.7 mmol/L和8 min。结论供体血清钠、谷丙转氨酶及热缺血时间是肝移植术后EAD的独立危险因素。供体血清钠及热缺血时间对评估公民逝世后器官捐献质量具有重要作用。
Objective The incidence of early allograft dysfunction(EAD)following deceased donor liver transplantation(DDLT)is high and affects the prognosis of the recipient. This study aimed to investigate the risk factors for EAD following DDLT.Methods This retrospective study included 79 cases of liver transplantation performed in the No. 900 Hospital of PLA Joint Logistic Support Force from January 2015 to December 2017. We collected the clinical data on the donors and recipients,propensity-score matched the pre-and intra-operative data on the recipients,and analyzed the risk factors for EAD identified among 17 donor-related variables.Results EAD was found in 26(32.9%)of the recipients. Univariate analysis showed statistically significant differences between the EAD and non-EAD groups in the body mass index,warm ischemia time,and cold ischemia time of the donors(P < 0.05),and so did multivariate logistic regression analysis in the levels of serum sodium and alanine aminotransferase and warm ischemia time of the donors(P < 0.05). The best cut-off values of the serum sodium level and warm ischemia time of the donors for predicting post-operative EAD were 152.7 mmol/L and 8 min,respectively.Conclusion The serum sodium and alanine aminotransferase levels and warm ischemia time of the donors are independent risk factors for EAD after DDLT. The serum sodium level and warm ischemia time of the donors play an important role in evaluating the quality of deceased donor organs.
Objective The incidence of early allograft dysfunction(EAD)following deceased donor liver transplantation(DDLT)is high and affects the prognosis of the recipient. This study aimed to investigate the risk factors for EAD following DDLT.Methods This retrospective study included 79 cases of liver transplantation performed in the No. 900 Hospital of PLA Joint Logistic Support Force from January 2015 to December 2017. We collected the clinical data on the donors and recipients,propensity-score matched the pre-and intra-operative data on the recipients,and analyzed the risk factors for EAD identified among 17 donor-related variables.Results EAD was found in 26(32.9%)of the recipients. Univariate analysis showed statistically significant differences between the EAD and non-EAD groups in the body mass index,warm ischemia time,and cold ischemia time of the donors(P < 0.05),and so did multivariate logistic regression analysis in the levels of serum sodium and alanine aminotransferase and warm ischemia time of the donors(P < 0.05). The best cut-off values of the serum sodium level and warm ischemia time of the donors for predicting post-operative EAD were 152.7 mmol/L and 8 min,respectively.Conclusion The serum sodium and alanine aminotransferase levels and warm ischemia time of the donors are independent risk factors for EAD after DDLT. The serum sodium level and warm ischemia time of the donors play an important role in evaluating the quality of deceased donor organs.
引文
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[12] Croome KP,Wall W,Quan D,et al. Evaluation of the updated definition of early allograft dysfunction in donation after brain death and donation after cardiac death liver allografts[J]. Hepatobiliary Pancreat Dis Int,2012,11(4):372-376.
[13] Firl DJ,Hashimoto K,O'Rourke C,et al. Impact of donor age in liver transplantation from donation after circulatory death donors:A decade of experience at Cleveland Clinic[J]. Liver Transpl,2016,21(12):1494-1503.
[14]马毅.肝脏移植热缺血损伤的研究进展[J].中华肝胆外科杂志,2001,7(8):508-510.
[15] Cywes R,Greig PD,Morgan GR,et al. Rapid donor liver nutritional enhancement in a large animal model[J]. Hepatology,1992,16(5):1271-1279.
[16] Ikeda T,Yanaga K,Kishikawa K,et al. Ischemic injury in liver transplantation:Difference in injury sites between warm and cold ischemia in rats[J]. Hepatology,1992,16(2):454-461.
[17] Jd VDB,Kranenburg O,Nijkamp MW,et al. Ischemia/reperfusion accelerates the outgrowth of hepatic micrometastases in a highly standardized murine model.[J]. Hepatology,2010,42(1):165-175.
[18] Bhogal RH,Sutaria R,Afford SC. Hepatic liver ischemia/reperfusion injury:processes in inflammatory networks--a review[J].Liver Transpl,2011,16(9):1016-1032.
[19] Lee KW,Simpkins CE,Montgomery RA,et al. Factors affecting graft survival after liver transplantation from donation after cardiac death donors[J]. Transplantation,2006,82(12):1683-1688.
[20] Mateo R,Cho Y,Singh G,et al. Risk factors for graft survival after liver transplantation from donation after cardiac death donors:an analysis of OPTN/UNOS data[J]. Am J Transplant,2006,6(4):791-796.
[21]何晓顺,鞠卫强,朱泽斌."无缺血"器官移植时代的来临与展望[J].中华普通外科学文献(电子版),2018,12(2):73-75.
[22]郭明晓,李幼生.器官保存研究进展及展望[J].医学研究生学报,2011,24(11):1216-1221.
[2]施晓雷.肝癌肝移植术后肿瘤复发的围手术期防治措施[J].医学研究生学报,2017,30(8):785-791.
[3] Lee DD,Croome KP,Shalev JA,et al. Early allograft dysfunction after liver transplantation:An intermediate outcome measure for targeted improvements[J]. Anna Hepatol,2016,15(1):53-60.
[4]王华翔,柯瑞盛,江艺,等.公民死亡器官捐献供肝与司法途径标准供肝移植术后胆道并发症和肝功能恢复情况比较[J].中华肝胆外科杂志,2018,24(7):437-441.
[5] Wadei HM,Lee DD,Croome KP,et al. Early Allograft Dysfunction After Liver Transplantation Is Associated With Shortand Long-Term Kidney Function Impairment[J]. Am J Transpl,2016,16(3):850-859.
[6] Hoyer DP,Paul A,Gallinat A,et al. Donor information based prediction of early allograft dysfunction and outcome in liver transplantation[J]. Liver Int,2015,35(1):156-163.
[7] Selten JW,Verhoeven C J,Heedfeld V,et al. The release of microRNA2 during liver preservation is associated with early allograft dysfunction and graft survival aftertransplantation[J]. Liver Transpl,2017,23(7):946-956.
[8] Tector AJ,Mangus RS,Chestovich P,et al. Use of extended criteria livers decreases wait time for liver transplantation without adversely impacting post transplant survival[J]. Ann Surg,2006,244(3):439-450.
[9]杨煜.供体获取前高钠血症对肝移植预后的影响[D].浙江大学,2017.
[10]丁利民,徐志丹,李新长,等.公民逝世后器官捐献供肝保护及功能评估临床分析[J].器官移植,2017(6):430-434.
[11]赵强,邓雯,陈茂根,等.公民器官捐献肝移植术后早期肝功能不全49例危险因素分析[J].中华普通外科学文献(电子版),2015(2):26-29.
[12] Croome KP,Wall W,Quan D,et al. Evaluation of the updated definition of early allograft dysfunction in donation after brain death and donation after cardiac death liver allografts[J]. Hepatobiliary Pancreat Dis Int,2012,11(4):372-376.
[13] Firl DJ,Hashimoto K,O'Rourke C,et al. Impact of donor age in liver transplantation from donation after circulatory death donors:A decade of experience at Cleveland Clinic[J]. Liver Transpl,2016,21(12):1494-1503.
[14]马毅.肝脏移植热缺血损伤的研究进展[J].中华肝胆外科杂志,2001,7(8):508-510.
[15] Cywes R,Greig PD,Morgan GR,et al. Rapid donor liver nutritional enhancement in a large animal model[J]. Hepatology,1992,16(5):1271-1279.
[16] Ikeda T,Yanaga K,Kishikawa K,et al. Ischemic injury in liver transplantation:Difference in injury sites between warm and cold ischemia in rats[J]. Hepatology,1992,16(2):454-461.
[17] Jd VDB,Kranenburg O,Nijkamp MW,et al. Ischemia/reperfusion accelerates the outgrowth of hepatic micrometastases in a highly standardized murine model.[J]. Hepatology,2010,42(1):165-175.
[18] Bhogal RH,Sutaria R,Afford SC. Hepatic liver ischemia/reperfusion injury:processes in inflammatory networks--a review[J].Liver Transpl,2011,16(9):1016-1032.
[19] Lee KW,Simpkins CE,Montgomery RA,et al. Factors affecting graft survival after liver transplantation from donation after cardiac death donors[J]. Transplantation,2006,82(12):1683-1688.
[20] Mateo R,Cho Y,Singh G,et al. Risk factors for graft survival after liver transplantation from donation after cardiac death donors:an analysis of OPTN/UNOS data[J]. Am J Transplant,2006,6(4):791-796.
[21]何晓顺,鞠卫强,朱泽斌."无缺血"器官移植时代的来临与展望[J].中华普通外科学文献(电子版),2018,12(2):73-75.
[22]郭明晓,李幼生.器官保存研究进展及展望[J].医学研究生学报,2011,24(11):1216-1221.