自身免疫性疾病与肝移植受者围手术期血栓形成并发症相关：一项器官共享联合网络（UNOS）数据库分析。
Autoimmune conditions are associated with perioperative thrombotic complications in liver transplant recipients: A UNOS database analysis.
作者信息
Bezinover Dmitri, Iskandarani Khaled, Chinchilli Vernon, McQuillan Patrick, Saner Fuat, Kadry Zakiyah, Riley Thomas R, Janicki Piotr K
机构信息
Department of Anesthesiology, Penn State College of Medicine/Penn State Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
Department of Public Health Sciences, Penn State College of Medicine/Penn State Hershey Medical Center, 90 Hope Drive, Hershey, PA, 17033, USA.
出版信息
BMC Anesthesiol. 2016 May 21;16(1):26. doi: 10.1186/s12871-016-0192-3.
BACKGROUND
End stage liver disease (ESLD) is associated with significant thrombotic complications. In this study, we attempted to determine if patients with ESLD, due to oncologic or autoimmune diseases, are susceptible to thrombosis to a greater extent than patients with ESLD due to other causes.
METHODS
In this retrospective study, we analyzed the UNOS database to determine the incidence of thrombotic complications in orthotopic liver transplant (OLT) recipients with autoimmune and oncologic conditions. Between 2000 and 2012, 65,646 OLTs were performed. We found 4,247 cases of preoperative portal vein thrombosis (PVT) and 1,233 cases of postoperative vascular thrombosis (VT) leading to graft failure.
RESULTS
Statistical evaluation demonstrated that patients with either hepatocellular carcinoma (HCC) or autoimmune hepatitis (AIC) had a higher incidence of PVT (p = 0.05 and 0.03 respectively). Patients with primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and AIC had a higher incidence of postoperative VT associated with graft failure (p < 0.0001, p < 0.0001, p = 0.05 respectively). Patients with preoperative PVT had a higher incidence of postoperative VT (p < 0.0001). Multivariable logistic regression demonstrated that patients with AIC, and BMI ≥40, having had a transjugular intrahepatic portosystemic shunt, and those with diabetes mellitus were more likely to have preoperative PVT: odds ratio (OR)(1.36, 1.19, 1.78, 1.22 respectively). Patients with PSC, PBC, AIC, BMI ≤18, or with a preoperative PVT were more likely to have a postoperative VT: OR (1.93, 2.09, 1.64, 1.60, and 2.01, respectively).
CONCLUSION
Despite the limited number of variables available in the UNOS database potentially related to thrombotic complications, this analysis demonstrates a clear association between autoimmune causes of ESLD and perioperative thrombotic complications. Perioperative management of patients at risk should include strategies to reduce the potential for these complications.
背景
终末期肝病（ESLD）与严重的血栓形成并发症相关。在本研究中，我们试图确定因肿瘤或自身免疫性疾病导致的ESLD患者是否比因其他原因导致的ESLD患者更易发生血栓形成。
方法
在这项回顾性研究中，我们分析了器官共享联合网络（UNOS）数据库，以确定患有自身免疫性和肿瘤性疾病的原位肝移植（OLT）受者血栓形成并发症的发生率。2000年至2012年间，共进行了65646例OLT手术。我们发现4247例术前门静脉血栓形成（PVT）和1233例术后血管血栓形成（VT）导致移植失败。
结果
统计评估表明，肝细胞癌（HCC）或自身免疫性肝炎（AIC）患者的PVT发生率较高（分别为p = 0.05和0.03）。原发性胆汁性肝硬化（PBC）、原发性硬化性胆管炎（PSC）和AIC患者术后与移植失败相关的VT发生率较高（分别为p < 0.0001、p < 0.0001、p = 0.05）。术前有PVT的患者术后VT发生率较高（p < 0.0001）。多变量逻辑回归表明，AIC患者、BMI≥40、曾接受经颈静脉肝内门体分流术以及糖尿病患者更易发生术前PVT：比值比（OR）分别为（1.36、1.19、1.78、1.22）。PSC、PBC、AIC、BMI≤18或术前有PVT的患者更易发生术后VT：OR分别为（1.93、2.09、1.64、1.60和2.01）。
结论
尽管UNOS数据库中与血栓形成并发症潜在相关的变量数量有限，但该分析表明ESLD的自身免疫性病因与围手术期血栓形成并发症之间存在明显关联。对有风险的患者进行围手术期管理应包括降低这些并发症发生可能性的策略。
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