公民逝世后器官捐献原位肝移植后早期肝功能不全的危险因素分析

目的 观察公民逝世后器官捐献原位肝移植术后早期肝功能不全（early allograft dysfunction，EAD）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2017年1月至2019年12月间我院65例行肝移植供、受体资料。根据术后情况将患者分为EAD组（n=29）及非EAD组（n=35）。对相关因素先进行单因素分析，然后将统计学差异的因素进行多因素Logistic回归模型分析。结果 65例原位肝移植患者术后早期肝功能不全的患者有29例，发生率为44.6%。单因素分析显示EAD组与非EAD组供体血清钠[（157.53±21.71）mmol/L vs（146.06±15.24）mmol/L，P=0.019]、热缺血时间[（21.6±6.5）min vs（10.6±4.3）min，P=0.016]、冷缺血时间[（8.3±1.2）h vs（5.4±1.2）h，P=0.012]、ICU住院时间[（78.1±19.5）h vs（49.7±17.6）h，P=0.007]及受体的无肝期时间[（98.3±16.3）h vs（66.0±17.6）h，P=0.037]差异均有统计学意义。多因素Logistic回归分析结果显示影响术后早期肝功能不全的独立危险因素为供体血清钠水平（OR 18.372，95%CI 1.846～24.173，P=0.019）及热缺血时间（OR 8.105，95%CI 1.513～37.205，P=0.013）。结论 供体血清钠水平及热缺血时间是公民逝世后器官原位肝移植术后EAD的独立危险因素。

Risk factors for early allograft dysfunction after deceased donor orthotopic liver transplantation

Objective To investigate the incidence of early allograft dysfunction (EAD) after orthotopic liver transplantation from donation after cardiac death (DCD) and the risk factors for EAD. Methods A retrospective study was performed for the clinical data of 65 donors and recipients who underwent orthotopic liver transplantation in hospital. Patients were divided into EAD group and non-EAD group. The related factors were analyzed by single factor analysis, and then the factors with significant difference were analyzed by multiple Logistic regression model. Results EAD was found in 29(44.6%) of the recipients. Univariate analysis showed statistical significant differences between the EAD and non-EAD groups in the levels of serum sodium [(157.53± 21.71)mmol/L vs (146.06±15.24)mmol/L, P=0.019], the warm [(21.6±6.5)min vs (10.6±4.3)min, P=0.016] and cold ischemia time [(8.3±1.2)h vs (5.4±1.2)h, P=0.012], the ICU hospital stay of the donors [(78.1±19.5)h vs(49.7±17.6)h, P=0.007] and the anhepatic time of receptor [(98.3±16.3)h vs (66.0±17.6)h, P=0.037]. Multivariate logistic regression analysis showed that the independent ridk factors were the levels of serum sodium (OR18.372, 95%CI 1.846~24.173, P=0.019) and warm ischemia time of the donors (OR 8.105, 95%CI 1.513~37.205,P=0.013). Conclusion The levels of serum sodium and warm ischemia time of the donors are the independent risk factors for EAD after deceased donor orthotopic liver transplantation.