Bertacco A, Barbieri S, Guastalla G, Boetto R, Vitale A, Zanus G, Cillo U, Feltracco P
Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy.
Department of Medicine, UO Anesthesia and Intensive Care, Padua University, Padua, Italy.
Transplant Proc. 2019 Jan-Feb;51(1):179-183. doi: 10.1016/j.transproceed.2018.06.025. Epub 2018 Jun 28.
Liver transplantation (LT) is an established treatment for patients with end-stage liver disease. The significant advances in surgical technique, immunosuppression therapy, and anesthesiological management have dramatically improved short- and long-term outcomes. The aim of this study is to correlate specific surgical and anesthesiological variables with causes of early death in LT recipients.
A retrospective observational analysis of adult patients who underwent LT in the period 2012 to 2016 and died within 90 days following LT was conducted. Exclusion criteria were intraoperative death, split liver, and domino transplant. Death was considered a dependent variable and classified into 3 different groups: death by sepsis, vascular events not related to the graft, and primary non-function. Donor and recipient variables were considered and analyzed using Fisher's exact test.
Statistically significative associations (P value < .05) were found between renal function support, retransplantation, and the number of fresh frozen plasma units transfused in one group and early death due to sepsis in the other.
This study identified some risk factors associated with the specific cause of early death in liver transplantation. The clinical implications of these findings are the ability to stratify patients at high risk of early death by planning more intensive and accurate management for them.
肝移植（LT）是终末期肝病患者的既定治疗方法。手术技术、免疫抑制治疗和麻醉管理方面的重大进展显著改善了短期和长期预后。本研究的目的是将特定的手术和麻醉变量与肝移植受者早期死亡原因相关联。
对2012年至2016年期间接受肝移植并在肝移植后90天内死亡的成年患者进行回顾性观察分析。排除标准为术中死亡、劈离式肝移植和多米诺移植。死亡被视为因变量，并分为3个不同组：败血症死亡、与移植物无关的血管事件和原发性无功能。使用Fisher精确检验对供体和受体变量进行考虑和分析。
在一组中，肾功能支持、再次移植和输注新鲜冰冻血浆单位数量与另一组因败血症导致的早期死亡之间存在统计学显著关联（P值<0.05）。
本研究确定了一些与肝移植早期死亡特定原因相关的危险因素。这些发现的临床意义在于能够通过为高危患者制定更强化和准确的管理方案，对早期死亡高危患者进行分层。
