公民身后器官捐献肝移植术后早期细菌和真菌感染并发症的临床特点与危险因素分析

目的对比分析公民身后器官捐献与传统司法途径器官捐献肝移植术后早期受体细菌和真菌感染并发症的临床特点，探讨公民身后器官捐献肝移植受体术后感染的危险因素。 方法回顾性研究2011年1月至2013年12月间本中心实施的公民身后器官捐献肝脏供、受体（研究组）和司法途径来源器官捐献的肝移植受体病例（对照组），比较两组受体术后细菌、真菌感染的临床特点和预后，分析术后受体感染的危险因素。 结果共纳入公民身后器官捐献肝脏供体43例；研究组受体72例，对照组受体80例。研究组受体的细菌、真菌感染总发生率显著高于对照组（47.2% vs 31.2%）（χ²=4.071，P=0.044）。研究组受体术后1周内的细菌感染率高于对照组（64.5% vs 38.2%）（χ²=6.133，P=0.018）。供体捐献前感染和开放性创伤史是术后受体感染的独立危险因素（P=0.025、0.031）。4例疑似供体来源性受体感染，占研究组总感染例数的11.8%（4/34）。 结论使用公民身后器官捐献来源器官的肝移植术后受体感染发生率显著高于传统司法途径来源，发生细菌感染的时间更早。供体器官捐献前存在感染和有开放性创伤是肝移植术后受体发生感染的危险因素。

Analysis of clinical features and risk factors of bacteria and fungal infectious complications in early postoperative liver transplant recipients using organ from donation after citizens death

ObjectiveTo compare the clinical characteristics of bacteria and fungal infectious complications after liver transplantation between using donation after citizen death and donation from executed prisoners and to find out the risk factors of infection after liver transplantation using donor after citizen death. MethodsThe clinical data of donor after citizen death and liver transplant recipients using donor after citizen death and donor from executed prisoners in our center from Jan 2011 to Dec 2013 were retrospectively analyzed. The clinical characteristics and prognosis of bacteria and fungal infectious complications after liver transplantation in both groups were compared to find out the risk factors of infection in liver transplantation using donor after citizen death. ResultsForty-three donors after citizen death and 152 liver transplantation recipients were included in the study, including 72 recipients using donors after citizen death and 80 recipients using donors from executed prisoners. The bacteria and fungal infection rates were significantly higher in the recipients using donors after citizen death (47.2%) than recipients using donors from executed prisoners (31.2%) (χ²=4.071, P=0.044). Among the donors after citizen death whose recipients suffered infectious complications, the rates of infection before organ donation and open wound were 57.9% and 21.1%, which were significantly higher than donors whose recipients did not have infectious complications (P=0.025, 0.031, respectively). Moreover, 4 probable cases of donor-derived infection after liver transplantation were diagnosed, accounting for 11.8% of the infections in liver transplant recipients using donor after citizen death. ConclusionsThe bacteria and fungal infection rates are significantly higher in the liver transplant recipients using donors after citizen death than recipients using donors from executed prisoners. Using donors with infection or open wound before organ donation may increase the risk of bacteria and fungal infectious complications after liver transplantation.