肝移植受者早期移植物功能障碍修订定义相关的预测模型及危险因素

Predictive model and risk factors associated with a revised definition of early allograft dysfunction in liver transplant recipients.

作者信息

Nicolau-Raducu Ramona, Cohen Ari J, Bokhari Amjad, Bohorquez Humberto, Bruce David, Carmody Ian, Bugeaud Emily, Seal John, Sonnier Dennis, Nossaman Bobby, Loss George

机构信息

Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA, USA.

Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA.

出版信息

Clin Transplant. 2017 Nov;31(11). doi: 10.1111/ctr.13097. Epub 2017 Sep 21.

DOI:10.1111/ctr.13097

PMID:28856732

Abstract

INTRODUCTION

Early allograft dysfunction (EAD) is a well-defined clinical syndrome that reflects overall graft function within the first week after transplant. The aim of this study was to further refine the definition for EAD.

METHOD

In this study, 1124 patients were included for analysis. Logistic regression was performed to identify markers of liver injury associated with 6-month patient and graft failure.

RESULTS

Recursive partitioning identified cut-points for ALT/AST > 3000/6000 IU/dL observed within first week, with bilirubin ≥ 10 mg/dL and INR ≥ 1.6 on postoperative day 7 for the revised EAD model. The incidence of updated EAD was 15% (164/1124). Multivariable analysis identified eight risk factors associated with EAD: % macrosteatosis, donor location, donor weight, nonheart beating donors, type of organ transplanted, recipient-associated hepatocellular carcinoma, severity of postreperfusion syndrome, and the amount of transfused fresh frozen plasma. In the presence of EAD, the incidence of post-transplant renal replacement therapy and dialysis dependence increases. There was a significant association of the presence of EAD with 6-month mortality (12% vs 3%) and 6-month graft failure (8% vs 1%).

CONCLUSION

Higher AST/ALT level needed as cutoff in comparison with the old EAD definition.

摘要

引言

早期移植肝功能障碍（EAD）是一种明确的临床综合征，反映移植后第一周内的整体移植肝功能。本研究的目的是进一步完善EAD的定义。

方法

本研究纳入1124例患者进行分析。采用逻辑回归分析确定与6个月时患者和移植物失败相关的肝损伤标志物。

结果

递归划分确定了修订后的EAD模型在第一周内观察到的ALT/AST > 3000/6000 IU/dL的切点，术后第7天胆红素≥10 mg/dL且INR≥1.6。更新后的EAD发生率为15%（164/1124）。多变量分析确定了与EAD相关的8个危险因素：大脂肪变性百分比、供体位置、供体体重、非心脏跳动供体、移植器官类型、受体相关肝细胞癌、再灌注综合征严重程度以及输注的新鲜冰冻血浆量。存在EAD时，移植后肾脏替代治疗和透析依赖的发生率增加。EAD的存在与6个月死亡率（12%对3%）和6个月移植物失败（8%对1%）显著相关。