Derbisz K, Nylec M, Chrząszcz P, Wrońska W, Kunsdorf-Wnuk A, Wystrychowski W, Król R
Department of General, Vascular and Transplant Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
Department of Anesthesiology and Intensive Care, Mielecki Hospital, Katowice, Poland.
Transplant Proc. 2018 Sep;50(7):2018-2021. doi: 10.1016/j.transproceed.2018.02.112. Epub 2018 Mar 13.
Primary graft dysfunction (PGD) is a multifactorial syndrome related to the most adverse outcomes after liver transplantation. Ischemia-reperfusion injury is recognized as the predominant cause of this complication. PGD may be subdivided into early allograft dysfunction, diagnosed by the presence of a serum bilirubin level ≥10 mg/dL (171 μmol/L), International Normalized Ratio ≥1.6, or alanine and aspartate transaminase levels ≥2000 IU/L on the seventh postoperative day; and primary nonfunction, defined as either a need for retransplantation or patient death within the first 7 days. We aimed to determine the preoperative and intraoperative risk factors for PGD.
We enrolled 109 patients who underwent orthotopic liver transplantation between 2012 and 2016. Analysis included inter alia: biochemical parameters, morphology, blood transfusions, as well as intraoperative fluctuations of blood pressure.
Fourteen percent of patients were diagnosed with PGD. Using logistic regression and multivariate and receiver operating characteristic and area under the curve analysis, a preoperative neutrophils level above 4030/μL (OR = 4.03, P = .012) and decrease of the mean arterial pressure after reperfusion were recognized as the major independent PGD risk factors.
A high preoperative neutrophils level may be a novel recipient-related risk factor for PGD. A decrease of the arterial blood pressure after graft reperfusion may influence the development of PGD.
原发性移植肝无功能（PGD）是一种多因素综合征，与肝移植后最不良的预后相关。缺血再灌注损伤被认为是这种并发症的主要原因。PGD可细分为早期移植肝无功能，其诊断标准为术后第7天血清胆红素水平≥10mg/dL（171μmol/L）、国际标准化比值≥1.6或丙氨酸和天冬氨酸转氨酶水平≥2000IU/L；以及原发性无功能，定义为在术后7天内需要再次移植或患者死亡。我们旨在确定PGD的术前和术中危险因素。
我们纳入了2012年至2016年间接受原位肝移植的109例患者。分析内容尤其包括：生化参数、形态学、输血情况以及术中血压波动。
14%的患者被诊断为PGD。通过逻辑回归、多变量分析、受试者工作特征曲线分析和曲线下面积分析，术前中性粒细胞水平高于4030/μL（OR = 4.03，P = 0.012）以及再灌注后平均动脉压下降被确定为PGD的主要独立危险因素。
术前中性粒细胞水平升高可能是一种新的与受体相关的PGD危险因素。移植肝再灌注后动脉血压下降可能影响PGD的发生。
