Lozano P, Orue-Echebarria M I, Asencio J M, Sharma H, Lisbona C J, Olmedilla L, Pérez Peña J M, Salcedo M M, Skaro A, Velasco E, Colón A, Díaz-Zorita B, Rodríguez L, Ferreiroa J, López-Baena J Á
Liver Transplant Unit, Hospital Universitario Gregorio Marañón de Madrid, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
Liver Transplant Unit, Hospital Universitario Gregorio Marañón de Madrid, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
Transplant Proc. 2019 Jan-Feb;51(1):50-55. doi: 10.1016/j.transproceed.2018.03.138. Epub 2019 Jan 14.
The increase in indications for liver transplantation has led to acceptance of donors with expanded criteria. The donor risk index (DRI) was validated with the aim of being a predictive model of graft survival based on donor characteristics. Intraoperative arterial hepatic flow and indocyanine green clearance (plasma clearance rate of indocyanine green [ICG-PDR]) are easily measurable variables in the intraoperative period that may be influenced by graft quality. Our aim was to analyze the influence of DRI on intraoperative liver hemodynamic alterations and on intraoperative dynamic liver function testing (ICG-PDR).
This investigation was an observational study of a single-center cohort (n = 228) with prospective data collection and retrospective data analysis. Measurement of intraoperative flow was made with a VeriQ flowmeter based on measurement of transit time (MFTT). The ICG-PDR was obtained from all patients with a LiMON monitor (Pulsion Medical Systems AG, Munich, Germany). DRI was calculated using a previously validated formula. Normally distributed variables were compared using Student's t test. Otherwise, the Mann-Whitney U test or Kruskal-Wallis test was applied, depending on whether there were 2 or more comparable groups. The qualitative variables and risk measurements were analyzed using the chi-square test. P < .05 was considered statistically significant.
DRI score (mean ± SD) was 1.58 ± 0.31. The group with DRI >1.7 (poor quality) had an intraoperative arterial flow of 234.2 ± 121.35 mL/min compared with the group having DRI < 1.7 (high quality), with an intraoperative arterial flow of 287.24 ± 156.84 mL/min (P = .02). The group with DRI >1.70 had an ICG-PDR of 14.75 ± 6.52%/min at 60 minutes after reperfusion compared to the group with DRI <1.70, with an ICG-PDR of 16.68 ± 6.47%/min at 60 minutes after reperfusion (P = .09).
Poor quality grafts have greater susceptibility to ischemia-reperfusion damage. Decreased intraoperative hepatic arterial flow may represent an increase in intrahepatic resistance early in the intraoperative period.
肝移植适应证的增加促使人们接受扩大标准供体。供体风险指数（DRI）经验证可作为基于供体特征的移植物存活预测模型。术中肝动脉血流和吲哚菁绿清除率（吲哚菁绿血浆清除率[ICG-PDR]）是术中易于测量的变量，可能受移植物质量影响。我们的目的是分析DRI对术中肝脏血流动力学改变及术中动态肝功能检测（ICG-PDR）的影响。
本研究为单中心队列观察性研究（n = 228），采用前瞻性数据收集和回顾性数据分析。术中血流测量采用基于渡越时间测量（MFTT）的VeriQ流量计。ICG-PDR通过LiMON监测仪（德国慕尼黑普升医疗系统公司）从所有患者获取。DRI使用先前验证的公式计算。正态分布变量采用Student's t检验进行比较。否则，根据是否有2个或更多可比组，应用Mann-Whitney U检验或Kruskal-Wallis检验。定性变量和风险测量采用卡方检验分析。P <.05被认为具有统计学意义。
DRI评分（均值±标准差）为1.58±0.31。DRI>1.7（质量差）组术中动脉血流为234.2±121.35 mL/min，而DRI<1.7（质量好）组术中动脉血流为287.24±156.84 mL/min（P =.02）。与DRI<1.70组相比，DRI>1.70组再灌注60分钟时的ICG-PDR为14.75±6.52%/min，DRI<1.70组再灌注60分钟时的ICG-PDR为16.68±6.47%/min（P =.09）。
质量差的移植物对缺血再灌注损伤更敏感。术中肝动脉血流减少可能意味着术中早期肝内阻力增加。
