肝移植术后初始肝功能不良的危险因素分析

目的 分析肝移植术后导致初始肝功能不良(IPGF)的危险因素.方法 随机选取2004年4月至11月行肝移植的32例患者为观察对象;将肝移植术后3 d内血清丙氨酸转氨酶(AI一)和/或天冬氨酸转氨酶(AST)峰值≥1 500 U/L的受者分为IPGF组,<1 500 U/L的受者分为非IPGF组.受者肝移植前分析指标为:年龄和MELD评分;供者分析指标为:年龄,供肝冷保存时间(CIT),供肝冷保存末期(Pr)、门脉灌注后4 h(Po)以及缺血再灌注损伤(IRI)的活检病理学评分;手术中的分析指标为:受者手术时间和移植肝复温缺血时间(RWIT).结果 所有受者术后均获得长期随访.32例受者中,IPGF组有10例,非IPGF组有22例.IPGF组和非IPGF组移植肝复温缺血时间分别为(55.00±12.91)min和(41.55±8.55)min,两组比较,差异有统计学意义(P<0.01);IPGF组术后肝功能恢复时间显著长于非IPGF组(P<0.01);IPGF组受者术后感染率明显高于非IPGF组(P<0.05).两组移植肝总体存活率分别为90.0%和95.5%,差异无统计学意义.两组移植肝按P0评分和IRI评分中的重度损伤标准发生IPGF的概率与轻、中度损伤比较,差异有统计学意义(P<0.05).结论 经二项分类logistic回归分析发现,移植肝复温缺血时间和缺血再灌注损伤是引起IPGF的危险因素.

Analysis of risk factors for initial poor graft function after liver transplantation

Objective To analyze the risk factors for initial poor graft function (IPGF) after liver transplantation (LT). Methods Thirty-two cases who underwent liver transplantation from April to November in 2004 were selected randomly. The group of IPGF was confirmed if ALT and/or AST was above 1 500 U/L while non-IPGF below 1 500 IU/L within 3 days after LT. The recipient associated factors included age, MELD score, the donor associated factors included age, cold preservation time, score of liver biopsy at the end of cold ischemia and 4 h after portal vein perfusion, the score of biopsy about IRI, and the operation associated factors included operative time and RWIT. Results All recipients were followed up after LT. There were 10 cases in IPGF group and 22 cases in non-IPGF group. RWIT was (55.00±12.91) rain in IPGF group and (41.55±8.55) rain in non- IPGF group respectively (P<0.01). The duration of liver function recovery in IPGF group was longer than in non-IPGF group after LT (P<0.01). The rate of postoperative infection in IPGF group was higher than in non-IPGF group after LT (P<0.05). The survival rate of graft was 90. 0 % in IPGF group and 95.5% in non-IPGF group respectively (P>0.05). By score of Po and IRI, the rate of IPGF was higher in severe injury group than in mild and moderate group (P<0.05). Conclusion By binary logistic regression, RWIT and IRI were the risk factors for 1PGF.