[肝移植术后预后不良患者的独立危险因素分析]
[Analysis of independent risk factor in patients with poor prognosis after liver transplantation].
作者信息
Zhu Ming-li, Li Yi, Qian Jia-qi, Xia Qiang, Wang Si-Yue, Lu Ren-hua, Che Miao-lin, Dai Hui-li, Ni Zhao-hui, Yan Yu-cheng
机构信息
Renal Division, Renji Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200127, China.
出版信息
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2009 Feb;21(2):69-73.
OBJECTIVE
To investigate the prognosis after orthotopic liver transplantation (OLT), and to elucidate the risk factors of poor prognosis in these patients.
METHODS
Adult recipients of OLT in Renji Hospital of Shanghai Jiaotong University were retrospectively analyzed. Data in pre-, intra- and post-OLT periods of these patients were collected. Acute kidney injury net (AKIN) criteria were used to analyze the post-OLT acute kidney injury (AKI). By following up all the patients for over a year, Kaplan-Meier survival analysis was used to evaluate the prognosis within 28 days and 1 year. Cox regression analysis was performed to evaluate risk factors of patient death, especially the influence of AKI on patient prognosis.
RESULTS
There were 193 patients enrolled, the average age was (48.07+/-10.02) years old. The ratio of male to female was 4:1. One hundred and sixteen patients (60.1%) were found to have AKI after OLT. Twenty-eight-day mortality of post-OLT AKI patients was higher than that without AKI patients [15.5%(18/116) vs. 0, P<0.05], 1 year survival rate of post-OLT AKI patients was lower than that without AKI patients [(70.7% (82/116) vs. 90.9 (70/77), P<0.05). Kaplan-Meier survival analysis showed the survival rate of non-AKI (77 patients), AKI stage 1, 2 and 3 patients (58, 25 and 33 patients respectively) post-OLT were 90.9%, 81.0%, 84.0% and 42.4%, respectively. All the non-survivors were discovered to have AKI within 28 days post-OLT. Cox regression analysis showed pre-OLT hypertension [hazard ratio (HR)=4.398, 95% confidence interval (CI)ú 1.535-12.604, P=0.006], post-OLT AKI (HR=12.100, 95%CI: 1.565-93.540, P=0.017), infection (HR=4.709, 95%CI: 1.813-12.226, P=0.001) and acute physiology and chronic health evaluation II (APACHE II) score > or =10 (HR=3.627, 95%CI: 1.244-10.573, P=0.018) were risk factors of 1 year death.
CONCLUSION
AKI is an independent risk factor of poor prognosis after liver transplantation. Prevention of AKI may improve the survival rate of OLT patients.
目的
探讨原位肝移植（OLT）后的预后情况，并阐明这些患者预后不良的危险因素。
方法
回顾性分析上海交通大学医学院附属仁济医院成年OLT受者。收集这些患者OLT术前、术中和术后的数据。采用急性肾损伤网络（AKIN）标准分析OLT术后急性肾损伤（AKI）。对所有患者进行一年以上的随访，采用Kaplan-Meier生存分析评估28天和1年的预后情况。进行Cox回归分析以评估患者死亡的危险因素，尤其是AKI对患者预后的影响。
结果
共纳入193例患者，平均年龄为（48.07±10.02）岁。男女比例为4:1。116例（60.1%）患者OLT术后发生AKI。OLT术后AKI患者的28天死亡率高于未发生AKI的患者[15.5%（18/116）对0，P<0.05]，OLT术后AKI患者的1年生存率低于未发生AKI的患者[（70.7%（82/116）对90.9%（70/77），P<0.05]。Kaplan-Meier生存分析显示，OLT术后非AKI患者（77例）、AKI 1期、2期和3期患者（分别为58例、25例和33例）的生存率分别为90.9%、81.0%、84.0%和42.4%。所有死亡患者均在OLT术后28天内发生AKI。Cox回归分析显示，OLT术前高血压[风险比（HR）=4.398，95%置信区间（CI）为1.535 - 12.604，P = 0.006]、OLT术后AKI（HR = 12.100，95%CI：1.565 - 93.540，P = 0.017）、感染（HR = 4.709，95%CI：1.813 - 12.226，P = 0.001）和急性生理与慢性健康状况评分II（APACHE II）≥10分（HR = 3.627，95%CI：1.244 - 10.573，P = 0.018）是1年死亡的危险因素。
结论
AKI是肝移植后预后不良的独立危险因素。预防AKI可能提高OLT患者的生存率。
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