Markmann James F, Markmann Joseph W, Desai Niraj M, Baquerizo Angeles, Singer Jennifer, Yersiz Hasan, Holt Curtis, Ghobrial Rafik M, Farmer Douglas G, Busuttil Ronald W
Department of Surgery, School of Medicine, Hospital of the University of Pennsylvania, 4th Floor Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA.
J Am Coll Surg. 2003 Apr;196(4):566-72. doi: 10.1016/S1072-7515(02)01907-5.
A growing discrepancy between the number of patients awaiting liver transplantation and the number of organs available mandates the use of even marginal organ donors in whom there is major risk of suboptimal graft function. A comprehensive analysis of operative parameters on the outcomes of liver transplantation has not been reported.
We analyzed the impact of 24 operative variables on the survival of 942 consecutive primary liver allografts performed at a single center from June 1992 through December 1997. Univariate and Cox proportional hazards analysis was used to identify those variables with independent prognostic significance in graft survival. Resource utilization for variables with multivariate significance was also analyzed.
Of 12 intraoperative variables found to have significance in univariate analysis, three were significant by Cox multivariate analysis: 1) lack of immediate bile production by the graft intraoperatively, 2) platelet transfusion > or = 20 U, and 3) recipient urine output < or =2.0 mL/kg/h intraoperatively. Each of the three variables was associated with marked increases in hospital and Intensive Care Unit length of stay and hospital charges accrued during the admission for transplantation.
We identified three operative parameters that predict a poor outcome after liver transplantation. The presence of these indicators suggests that early retransplantation should be considered. Early identification of grafts likely to have poor function might also provide an opportunity for therapeutic intervention to salvage graft function.
等待肝移植的患者数量与可用器官数量之间的差距日益增大，这就要求使用甚至是边缘性器官供体，而这些供体的移植肝功能欠佳风险很大。尚未有关于肝移植手术参数对肝移植结局影响的综合分析报告。
我们分析了1992年6月至1997年12月在单一中心连续进行的942例原位肝移植中24个手术变量对移植物存活的影响。采用单因素分析和Cox比例风险分析来确定那些在移植物存活方面具有独立预后意义的变量。还分析了具有多因素意义的变量的资源利用情况。
在单因素分析中发现有意义的12个术中变量中，有3个在Cox多因素分析中具有显著意义：1）术中移植物无即时胆汁生成，2）输注血小板≥20单位，3）术中受者尿量≤2.0毫升/千克/小时。这三个变量中的每一个都与住院时间、重症监护病房住院时间以及移植住院期间产生的住院费用显著增加相关。
我们确定了三个预测肝移植后预后不良的手术参数。这些指标的存在表明应考虑早期再次移植。早期识别可能功能欠佳的移植物也可能为挽救移植物功能的治疗干预提供机会。
