乙肝相关慢加急性肝衰竭患者肝移植术后影响生存的危险因素分析

目的:探讨影响乙肝相关慢加急性肝衰竭患者实施肝移植后短期病死率与长期生存的危险因素。方法:本研究通过前瞻性收集自2018年8月—2021年7月在首都医科大学附属北京佑安医院因乙肝相关慢加急性肝衰竭实施肝移植的患者40例，其中男性36例、女性4例，年龄为(44.5±8.79)岁。统计患者的基本资料、发病情况、肝移植前48...

Risk factors of short-term mortality after liver transplantation for hepatitis B-related acute-on-chronic liver failure

Objective To investigate the risk factors for short-term mortality and long-term survival after liver transplantation in patients with hepatitis B related acute-on-chronic liver failure.Methods Forty patients with hepatitis B related acute-on-chronic liver failure performing liver transplantation were prospectively collected from August 2018 to July 2021 in Beijing YouAn Hospital of Capital Medical University.The mean age was(44.5±8.79)years,there were 36 males and 4 females.The basic data,including liver and kidney function,blood routine,coagulation function,lactic acid,infection indexes as well as MELD score,MELD-Na score,CLIF-C ACLFs score,CLIF OFs score,CLIF grade within 48 hours before liver transplantation were counted.The post-LT mortality within 90 days and long-term survival were observed for these patients who were divided into survival group(n=34)and death group(n=6)according to the survival in 3 months after liver transplantation.The measurement data conforming to the normal distribution were expressed by mean±standard deviation(±s),and the comparison was performed by t-test between groups;The skewness data were expressed by M(Q1,Q3),and the rank sum test was used for inter-group comparison.The counting data were tested by Chi square test or Fisher exact probability method.The risk factors of short-term mortality and long-term survival were analyzed through univariate and multivariate analysis as well as survival analysis.The sensitivity,specificity and cut off value were calculated by ROC curve.The patients were divided into≥48.5 scores group(n=10)and<48.5 scores group(n=30)by CLIF-C ACLFs score 48.5 as cut-off value.Kaplan Meier was used for survival analysis and comparison.Results The total bilirubin(TBIL),creatinine(CR),platelet count,international normalized ratio(INR),lactic acid and neutrophil/lymphocyte ratio(NLR)within 48 hours before liver transplantation were 24.30(13.45,33.95)mg/dL,0.68(0.53,1.11)mg/dL and 56(39,82)×109/L,3.12(2.33,4.46),2.14(1.59,4.14)mmol/L,4.06(2.12,9.13)for all forty patients,respectively.The mean MELD,MELD Na,CLIF OFs,CLIF-C ACLFs and AARC scores within 48 hours before transplantation were(32.1±6.3),(33.2±5.3),(11.2±2.6),(43.8±8.8)and(10.6±2.4)scores,respectively.65%of patients were complicated with hepatic encephalopathy,17 patients with controllable systemic infection,10 patients with renal function injury,2 patients with variceal bleeding and 6 patients underwent ventilator-assisted ventilation(endotracheal intubation).All 40 patients underwent emergency orthotopic liver transplantation.The incidence of postoperative complications was 47.5%,the most common was post-LT infection(27.5%),followed by renal insufficiency(17.5%).There were significant differences in neutrophil lymphocyte ratio(NLR),lactic acid,MELD score,MELD Na score,CLIF-C ACLFs score,CLIF OFs score,CLIF grades,hepatic encephalopathy,infection and renal injury between survival group and death group(P<0.05).Univariate logistic regression analysis showed that NLR,MELD Na score,CLIF-C ACLFs score and CLIF OFs score were the risk factors for short-term mortality after liver transplantation(P<0.05).Multivariate logistic regression analysis showed that CLIF-C ACLFs score was an independent risk factor for 3-month mortality after liver transplantation.ROC curve showed that the area under the curve of CLIF-C ACLFs score was 0.895(95%CI:0.779-1.000,P=0.002),and the diagnostic sensitivity and specificity were the highest,83.3%and 85.3%respectively when cut off value was 48.5.Meanwhile,there was significant difference in long-term survival between the patients with CLIF-C ACLFs score≥48.5 and<48.5(P=0.001).Conclusions NLR,MELD Na score,CLIF-C ACLFs score and CLIF OFs score within 48 hours before liver transplantation are the risk factors for short-term mortality after liver transplantation,however CLIF-C ACLFs score is an independent risk factor for three-months mortality and long-term survival in patients with hepatitis B related acute-on-chronic liver failure after liver transplantation.