肝移植受者早期移植物功能障碍的风险因素、手术并发症和移植物存活率。

Risk factors, surgical complications and graft survival in liver transplant recipients with early allograft dysfunction.

机构信息

Digestive and Hepatobiliary Surgery, Hospital São Vicente de Paulo, Rio de Janeiro, Brazil; Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.

Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.

出版信息

Hepatobiliary Pancreat Dis Int. 2019 Oct;18(5):423-429. doi: 10.1016/j.hbpd.2019.02.005. Epub 2019 Feb 25.

DOI:10.1016/j.hbpd.2019.02.005

PMID:30853253

Abstract

BACKGROUND

Early allograft dysfunction (EAD) is a severe complication after liver transplantation. The associated risk factors and complications have re-gained recent interest. This study investigated risk factors, survival and complications associated with EAD in a large liver transplant center in Latin America.

METHODS

Retrospective, unicenter, cohort, based on data from adult patients undergoing first deceased-donor liver transplant from January 2009 to December 2013. EAD was defined by one or more of the following: (i) bilirubin ≥10 mg/dL on postoperative day 7; (ii) international normalized ratio ≥1.6 on postoperative day 7, and (iii) alanine aminotransferase or aspartate aminotransferase >2000 IU/L within the first seven days after transplant.

RESULTS

A total of 602 patients were included; of these 34.2% developed EAD. Donor risk factors were male (P = 0.007), age between 50 and 59 years (P = 0.034), overweight (P = 0.028) or grade I obesity (P = 0.012), sodium >157 mmol/L (P = 0.002) and grade IV ischemia/reperfusion injury (P = 0.002). Cold ischemia time ≥10 h (P = 0.008) and warm ischemia time ≥40 min (P = 0.013) were the surgical factors. Male (P <0.001) was the only recipient protective factor. Compared with the non-EAD group, patients with EAD were submitted to more reoperations (24.3% vs. 13.4%, P = 0.001) and had higher graft loss rates (37.9% vs. 21.2%, P <0.001), with similar patient survival rates (P = 0.238).

CONCLUSIONS

EAD risk factors are related to donor, surgical procedure and recipient. Donor risk factors for EAD were male, age between 50 and 59 years, donor overweight or grade I obesity, sodium >157 mmol/L and grade IV ischemia/reperfusion injury. Cold ischemia time ≥10 h and warm ischemia time ≥40 min were the surgical risk factors. Male was the only recipient protective factor. Patients with EAD had higher reoperations and graft loss rates.

摘要

背景

早期移植物功能障碍（EAD）是肝移植后的一种严重并发症。其相关的风险因素和并发症再次引起了关注。本研究调查了拉丁美洲一家大型肝移植中心与 EAD 相关的风险因素、存活率和并发症。

方法

回顾性、单中心、队列研究，基于 2009 年 1 月至 2013 年 12 月期间接受首次尸源肝移植的成年患者的数据。EAD 通过以下一种或多种情况定义：（i）术后第 7 天胆红素≥10mg/dL；（ii）术后第 7 天国际标准化比值≥1.6；（iii）移植后前 7 天内丙氨酸氨基转移酶或天冬氨酸氨基转移酶>2000IU/L。

结果

共纳入 602 例患者，其中 34.2%发生 EAD。供体风险因素为男性（P=0.007）、年龄在 50 至 59 岁之间（P=0.034）、超重（P=0.028）或 I 级肥胖（P=0.012）、钠>157mmol/L（P=0.002）和 IV 级缺血再灌注损伤（P=0.002）。冷缺血时间≥10h（P=0.008）和热缺血时间≥40min（P=0.013）是手术因素。男性（P<0.001）是唯一的受者保护因素。与非 EAD 组相比，EAD 患者接受了更多的再次手术（24.3%比 13.4%，P=0.001），移植肝丢失率更高（37.9%比 21.2%，P<0.001），但患者生存率相似（P=0.238）。

结论

EAD 的风险因素与供体、手术过程和受者有关。EAD 的供体风险因素为男性、50 至 59 岁、供体超重或 I 级肥胖、钠>157mmol/L 和 IV 级缺血再灌注损伤。冷缺血时间≥10h 和热缺血时间≥40min 是手术风险因素。男性是唯一的受者保护因素。EAD 患者的再次手术和移植肝丢失率较高。