Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ 85718, USA.
Clin Transplant. 2013 Jul-Aug;27(4):E448-53. doi: 10.1111/ctr.12186.
The 15% mortality rate of liver transplant recipients at one yr may be viewed as a feat in comparison with the waiting list mortality, yet it nonetheless leaves room for much improvement. Our aim was to critically examine the mortality rates to identify high-risk periods and to incorporate cause of death into the analysis of post-transplant survival.
We performed a retrospective analysis on United Network for Organ Sharing data for all adult recipients of liver transplants from January 1, 2002 to October 31, 2011. Our analysis included multivariate logistic regression where the primary outcome measure was patient death of 49,288 recipients.
The highest mortality rate by day post-transplant was on day 0 (0.9%). The most significant risk factors were as follows: for one-d mortality from technical failure, intensive care unit admission odds ratio (OR 3.2); for one-d mortality from graft failure, warm ischemia >75 min (OR 5.6); for one-month mortality from infection, a previous transplant (OR 3.3); and for one-month mortality from graft failure, a previous transplant (OR 3.7).
We found that the highest mortality rate after liver transplantation is within the first day and the first month post-transplant. Those two high-risk periods have common, as well as different, risk factors for mortality.
与等待名单死亡率相比，肝移植受者一年死亡率为 15%，这可能被视为一项壮举，但仍有很大的改进空间。我们的目的是仔细检查死亡率，以确定高风险期，并将死亡原因纳入移植后生存分析。
我们对 2002 年 1 月 1 日至 2011 年 10 月 31 日期间所有接受肝移植的成年受者的器官共享网络数据进行了回顾性分析。我们的分析包括多元逻辑回归，主要观察指标是 49288 名受者的死亡。
肝移植后死亡率最高的是术后第 0 天（0.9%）。最显著的危险因素如下：技术失败导致 1 天内死亡的因素为重症监护病房入院比值比（OR3.2）；移植物功能衰竭导致 1 天内死亡的因素为热缺血>75 分钟（OR5.6）；感染导致 1 个月内死亡的因素为既往移植（OR3.3）；移植物功能衰竭导致 1 个月内死亡的因素为既往移植（OR3.7）。
我们发现肝移植后死亡率最高的是术后第 1 天和第 1 个月。这两个高风险期的死亡危险因素既有相同之处，也有不同之处。
