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肝移植后早期再次手术对移植物存活率的影响:单因素和多因素分析。

Impact of early reoperation on graft survival after liver transplantation: Univariate and multivariate analysis.

机构信息

MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, USA.

Gastroenterology Surgical Center, Department of Surgery, Mansoura University, Mansoura, Egypt.

出版信息

Clin Transplant. 2018 Jun;32(6):e13228. doi: 10.1111/ctr.13228. Epub 2018 May 28.

Abstract

BACKGROUND

Data on rate, risk factors, and consequences of early reoperation after liver transplantation are still limited.

STUDY DESIGN

Single-center retrospective analysis of data of 428 patients, who underwent liver transplantation in period between January 2009 and December 2014. Univariate and multivariate analysis were used to study the risk factors of early reoperation and its impact on graft survival.

RESULTS

Of 428 patients, 74 (17.3%) underwent early reoperation. Of them, 46 (62.2%) underwent reoperation within the first week and 28 (37.8%) underwent reoperation later than 1 week after transplantation. With multivariate analysis, significant risk factors of early reoperation included pretransplant ICU admission, previous abdominal surgery and diabetes. Early reoperation itself was not found to be an independent predictor of graft loss. However, early reoperation later than 7 days from transplant was found to be independent predictor of graft loss (odds ratio [OR] = 5.125; 95% CI, 1.358-19.552; P = .016). In our series, other independent predictors of graft loss were MELD score (P = .010) and operative time (P = .048).

CONCLUSIONS

This analysis demonstrates that early reoperations later than a week appear to negatively impact the graft survival. The timing of early reoperation should be a focus of additional studies.

摘要

背景

关于肝移植术后早期再次手术的发生率、风险因素和后果的数据仍然有限。

研究设计

对 2009 年 1 月至 2014 年 12 月期间在单中心接受肝移植的 428 例患者的数据进行了回顾性分析。采用单因素和多因素分析研究早期再次手术的风险因素及其对移植物存活率的影响。

结果

在 428 例患者中,74 例(17.3%)接受了早期再次手术。其中 46 例(62.2%)在移植后 1 周内再次手术,28 例(37.8%)在移植后 1 周后再次手术。多因素分析显示,早期再次手术的显著危险因素包括移植前 ICU 入院、既往腹部手术和糖尿病。早期再次手术本身并不是移植物丧失的独立预测因素。然而,移植后 7 天内的早期再次手术被发现是移植物丧失的独立预测因素(比值比 [OR] = 5.125;95%置信区间,1.358-19.552;P = 0.016)。在本系列中,移植物丧失的其他独立预测因素包括 MELD 评分(P = 0.010)和手术时间(P = 0.048)。

结论

这项分析表明,一周后出现的早期再次手术似乎对移植物存活率产生负面影响。早期再次手术的时机应成为进一步研究的重点。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fd3c/6433119/4e547a96cefc/nihms-1017967-f0001.jpg

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