Li C, Lu Q, Luo J, Zhang Z
Department of ICU, West China Hospital, Sichuan University, Chendu 610041, China.
Department of ICU, West China Hospital, Sichuan University, Chendu 610041, China.
Transplant Proc. 2014 Apr;46(3):883-7. doi: 10.1016/j.transproceed.2013.11.048.
This study sought to define the perioperative recipient and donor factors that contribute to the occurrence of massive ascites after living donor liver transplantation (LDLT) in adults.
A retrospective review of medical records and computerized databases was performed, and 105 adult patients who underwent LDLT from 2005 to 2011 in the West China Hospital, Sichuan University, were included. Patients were divided into group 1 (n = 27, massive ascites defined as >7000 mL of ascitic fluid produced during the first 7 days after LDLT) or group 2 (n = 78, no massive ascites). Perioperative recipient and donor factors were assessed using a univariate analysis followed by 2 logistic regression analyses.
The recipients' median age was 44 years (range, 27 to 69 years), and the male-to-female ratio was 92:13. Massive ascites developed in 27 patients (25.7%). The average amount of ascites in group 1 and group 2 patients within the first 7 postoperative days was 11,285 mL and 3311 mL, respectively. The univariate analysis showed that recipient's age, primary liver disease, preoperative MELD score, Child-Pugh score, operating time, postoperative sequential organ failure assessment (SOFA) score, postoperative total bilirubin, right hepatic vein graft diameter, and hepatic portal vein graft diameter were significantly different between the 2 groups (P < .05). The 2 logistic regressions showed that the Child-Pugh score, operating time, and right hepatic vein graft diameter were independent risk factors for massive ascites after LDLT.
It is important to improve the perioperative liver function and portal hypertension and to shorten operating time to reduce massive ascites after LDLT.
本研究旨在确定导致成人活体肝移植（LDLT）后发生大量腹水的围手术期受者和供者因素。
对病历和计算机数据库进行回顾性分析，纳入2005年至2011年在四川大学华西医院接受LDLT的105例成年患者。患者分为1组（n = 27，大量腹水定义为LDLT后第1个7天内产生的腹水量>7000 mL）或2组（n = 78，无大量腹水）。采用单因素分析评估围手术期受者和供者因素，随后进行2次逻辑回归分析。
受者的中位年龄为44岁（范围为27至69岁），男女比例为92:13。27例患者（25.7%）发生大量腹水。1组和2组患者术后第1个7天内的平均腹水量分别为11285 mL和3311 mL。单因素分析显示，两组之间受者年龄、原发性肝病、术前终末期肝病模型（MELD）评分、Child-Pugh评分、手术时间、术后序贯器官衰竭评估（SOFA）评分、术后总胆红素、右肝静脉移植血管直径和肝门静脉移植血管直径存在显著差异（P <.05）。2次逻辑回归显示，Child-Pugh评分、手术时间和右肝静脉移植血管直径是LDLT后发生大量腹水的独立危险因素。
改善围手术期肝功能和门静脉高压并缩短手术时间对于减少LDLT后大量腹水至关重要。
