Elkholy S, Mogawer S, Hosny A, El-Shazli M, Al-Jarhi U M, Abdel-Hamed S, Salah A, El-Garem N, Sholkamy A, El-Amir M, Abdel-Aziz M S, Mukhtar A, El-Sharawy A, Nabil A
Internal Medicine Department, Faculty of Medicine, Cairo University, Egypt.
Internal Medicine Department, Faculty of Medicine, Cairo University, Egypt.
Transplant Proc. 2017 Jul-Aug;49(6):1376-1382. doi: 10.1016/j.transproceed.2017.02.055.
Egypt has the highest prevalence of the world hepatitis C virus (HCV) load. Hence, the problem of end-stage liver disease (ESLD) is considered a huge burden on the community. Living donor liver transplantation (LDLT) is the only source of donation in Egypt till now. Survival rates had shown significant improvement in the past decades. This study provides analysis of the mortality rates and possible predictors of mortality following LDLT. It also aids in developing a practical and easy-to-apply risk index for prediction of early mortality.
This study is a retrospective study that was designed to analyze data from 128 adult patients with ESLD who underwent LDLT in the Liver Transplantation Unit at Faculty of Medicine, Cairo University. Early and late mortality were identified. All potential risk factors were tested using univariate regression for association with early and late mortality. Significant variables were then entered into a multivariable logistic regression model for identifying the predictors for mortality.
Sepsis was the most common cause of early mortality. Early mortality and 1-year mortality were 29 (23%) and 23 (18%), respectively. Model for End-Stage Liver Disease (MELD) score, intraoperative packed red blood corpuscles (RBCs), and duration of intensive care unit (ICU) stay were found to be independently associated with early mortality.
A MELD score >20, intraoperative transfusion >8 units of packed RBCs, and ICU stay >9 days are three independent predictors of early mortality. Their incorporation into a combined Risk Index can be used to improve outcomes of LDLT.
埃及是世界上丙型肝炎病毒（HCV）载量患病率最高的国家。因此，终末期肝病（ESLD）问题被认为是社区的巨大负担。活体供肝移植（LDLT）是目前埃及唯一的捐赠来源。在过去几十年中，生存率有了显著提高。本研究对LDLT后的死亡率及可能的死亡预测因素进行了分析。它还有助于制定一个实用且易于应用的早期死亡风险指数。
本研究为回顾性研究，旨在分析开罗大学医学院肝移植科128例接受LDLT的成年ESLD患者的数据。确定早期和晚期死亡率。使用单变量回归测试所有潜在风险因素与早期和晚期死亡率的相关性。然后将显著变量纳入多变量逻辑回归模型，以确定死亡预测因素。
脓毒症是早期死亡的最常见原因。早期死亡率和1年死亡率分别为29例（23%）和23例（18%）。终末期肝病模型（MELD）评分、术中浓缩红细胞（RBC）输注量和重症监护病房（ICU）住院时间被发现与早期死亡率独立相关。
MELD评分>20、术中输注浓缩红细胞>8单位和ICU住院时间>9天是早期死亡的三个独立预测因素。将它们纳入综合风险指数可用于改善LDLT的结果。
