心脏死亡者供肝移植术后受体早期肝功能恢复不良的影响因素分析

 目的 探讨“中国二类”(DCD)和“中国三类”(DBCD)心脏死亡器官捐献(统称为DCD)的供体和受体因素对肝移植术后早期肝功能恢复不良的影响。方法 回顾性分析2013-09至2017-01在解放军总医院第三医学中心实施的211例DCD肝移植的临床资料,主要包括供体和受体的性别、年龄、原发病、血型、体质量指数(BMI)、既往病史、ICU住院时间、机械通气时间、热缺血时间、冷缺血时间、术中出血量、MELD评分、术后早期肝功能及预后等指标。采用χ²检验及多因素Cox回归方法分析影响肝移植术后早期肝功能恢复及预后不良的风险因素。结果 受体术中出血量(P=0.046)、受体BMI(P=0.035)、受体MELD评分(P=0.000)、供体年龄(P=0.047)、供体性别(P=0.028)、供体血K⁺水平(P=0.001)、拔管到心脏停跳时间(P=0.001)、供体ICU住院天数(P=0.022)均与受体术后早期肝功能恢复不良有关。多因素分析显示:术中出血量(P=0.001,HR=12.512,95%CI: 2.679～58.434)、受体MELD分级(P=0.021,HR=3.991,95%CI:1.237～12.876)是独立风险因子。结论 控制术中出血量及选择MELD<25的受体将有助于改善DCD受者肝移植术后早期肝功能恢复不良及预后。

Analysis of influencing factors of early poor recovery of liver function after liver transplantation with organ donation for cardiac death

Objective To assessment the risk factors on poor early liver function recovery. of recipient after liver transplantation (LT) using allografts from donation after cardiac death (DCD) or brain and cardiac death(DBCD)donors.Methods In this retrospectively study, 211 liver transplantation using grafts from DCD or DBCD donors were performed at the Third Medical Center, General Hospital of Chinese PLA from September 2013 to January 2017. We collected data of recipient and donor including gender, age, primary disease, ABO blood type, body mass index (BMI), medical history (fatty liver, hypertension), ICU hospitalization time, mechanical ventilation time, warm ischemia time, cold ischemia time, intraoperative blood loss, operation time, Model for End-Stage Liver Disease (MELD) score and indexes of routine laboratory test, et al. Statistical analysis using the chi-square test, multivariate step-wise Cox regression were performed.Results Of the 211 patients, intraoperative blood loss (P=0.046), BMI (P=0.035), MELD score (P=0.000), and donor age (P=0.047), male gender (P=0.028), serum potassium level (P=0.001), extubation to cardiac arrest (P=0.004), as well as donor ICU hospitalization time (P=0.022) all related to the early liver dysfunction after LT. Multivariate step-wise Cox regression showed that the intraoperative blood loss(P=0.001,HR=12.512,95%CI: 2.679-58.434), MELD score(P=0.021,HR=3.991,95%CI: 1.237-12.876)were independent prognostic risk factors.Conclusions Controlling intraoperative blood loss and selecting receptors with MELD score <25 may further improve the early liver function and prognosis of recipients after LT.