使用乔治·洛佩斯-1研究所保存液进行的连续100例肝移植：结果与预后因素

One Hundred Consecutive Liver Transplants Using Institutes Georges Lopez-1 Preservation Solution: Outcomes and Prognostic Factors.

作者信息

Chedid M F, Bosi H R, Chedid A D, Alvares-da-Silva M R, Leipnitz I, Grezzana-Filho T J M, Reis M J, Filho G M, Ghissi A J, Neto P R, de Araujo A, Arruda S, Lopes A B, Michalczuk M T, Backes A N, Kruel C D P, Kruel C R P

机构信息

Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.

出版信息

Transplant Proc. 2017 May;49(4):848-851. doi: 10.1016/j.transproceed.2017.01.061.

DOI:10.1016/j.transproceed.2017.01.061

PMID:28457409

Abstract

BACKGROUND

There are only 4 prior studies reporting on outcomes of liver transplantation (LT) using Institutes Georges Lopez-1 (IGL-1) preservation solution. Detection of negative predictors of LT using IGL-1 may help finding strategies to protect selected recipients at higher risk of graft failure and death.

METHODS

Review of all consecutive adult patients who underwent a first whole-graft LT using IGL-1 at authors' institution from 2013 to 2016. Primary end point was graft failure within the first 90 postoperative days (PODs). Graft losses due to any cause (including all deaths with a functioning graft) were recorded as graft failures.

RESULTS

Of all 100 patients included in this study, 37 were women; median age was 58 years (range 18-71). There were 12 graft losses during the first 90 PODs (including 3 cases of primary nonfunction of the liver allograft), and 10 of the 12 graft losses occurred on first 30 PODs. All 12 patients who experienced graft loss (including 1 patient who underwent liver retransplantation) died within the first 90 PODs. Of the total 100 patients, 14 experienced biliary complications. Univariate analysis revealed prolonged warm ischemic time (WIT) as the only predictor of 90-day graft failure (odds ratio = 23.5, confidence interval = 1.29-430.18, P = .03). The cutoff by receiver operating characteristic curve for WIT was 38 minutes (area under the curve = 0.70). Positive predictive value for WIT >38 minutes was 94.3%.

CONCLUSIONS

LT using IGL-1 can be performed safely. Similar to prior reports on LT using other preservation solutions, prolonged WIT was associated with adverse outcomes.

摘要

背景

仅有4项先前的研究报告了使用乔治·洛佩斯研究所1号（IGL-1）保存液进行肝移植（LT）的结果。利用IGL-1检测肝移植的阴性预测指标可能有助于找到保护选定的、移植失败和死亡风险较高的受者的策略。

方法

回顾2013年至2016年在作者所在机构接受首次全肝移植且使用IGL-1的所有连续成年患者。主要终点是术后90天内的移植失败。因任何原因导致的移植丢失（包括所有移植功能正常的死亡病例）均记录为移植失败。

结果

本研究纳入的100例患者中,37例为女性；中位年龄为58岁（范围18-71岁）。术后90天内有12例移植丢失（包括3例肝移植原发性无功能），其中12例移植丢失中的10例发生在术后30天内。所有12例经历移植丢失的患者（包括1例接受再次肝移植的患者）均在术后90天内死亡。100例患者中，14例出现胆道并发症。单因素分析显示，延长的热缺血时间（WIT）是90天移植失败的唯一预测指标（比值比=23.5，置信区间=1.29-430.18，P=0.03）。WIT的受试者工作特征曲线的截断值为38分钟（曲线下面积=0.70）。WIT>38分钟的阳性预测值为94.3%。