Nafea Mohammed A, Alsebaey Ayman, Abd El Aal Sultan Ahmed, Goda Mohammed Hisham, Salman Ahmed, Rashed Hanaa Said, Soliman Ahmed, Elshenoufy Mai, Abdelrahman Mostafa
From the Department of General Surgery, Al-Azhar University, Cairo, Egypt.
From the Department of Gastroenterology and Hepatology, National Liver Institute, Shebin El-Kom, Egypt.
Ann Saudi Med. 2019 Sep-Oct;39(5):337-344. doi: 10.5144/0256-4947.2019.337. Epub 2019 Oct 3.
Living donor liver transplantation (LDLT) has evolved into a widely accepted therapeutic option. Many different risk factors may affect early mortality after LDLT.
Analyze risk factors that can affect early (<6 months) mortality of patients after LDLT in a single center.
Retrospective chart review of patients who underwent LDLT.
University hospital.
Adult cirrhotic patients who underwent LDLT were classified by early (first 6 months) or late mortality. A full pre, intra- and post-operative evaluation had been done on all patients including a full history, examination and investigations to identify risk factors that might affect mortality post-LDLT.
Determination of pre-, intra- or postoperative factors that might affect recipient mortality post-LDLT.
Pre-operative factors that increased early mortality in a univariate analysis were higher model for end-stage liver disease (MELD) scores, lower graft-recipient weigh ratio (GRWR), older donor age, and recurrent spontaneous bacterial peritonitis. Intraoperative factors included more transfusion units of blood, plasma, platelets and cryoprecipitate, a longer time for cold and warm ischemia, and a longer anhepatic phase among others. Postoperative factors included a longer ICU or hospital stay and abnormal postoperative laboratory data. In the final logistic regression model, the most significant factors were pre-operative GRWR, length of hospital stay, units of intraoperative blood transfusion, postoperative alanine aminotransferase, postoperative total leukocyte count, and MELD score.
LDLT outcomes might be improved by attempting to resolve clinical factors that have been identified as contributors to early post-LDLT mortality.
More risk factors, such as those relevant to patient portal vein hemodynamics, should be included in an analysis of predictors of early mortality.
None.
活体肝移植（LDLT）已发展成为一种被广泛接受的治疗选择。许多不同的风险因素可能会影响LDLT后的早期死亡率。
分析在单一中心中可能影响LDLT患者早期（<6个月）死亡率的风险因素。
对接受LDLT患者的回顾性病历审查。
大学医院。
接受LDLT的成年肝硬化患者按早期（前6个月）或晚期死亡率进行分类。对所有患者进行了全面的术前、术中和术后评估，包括完整的病史、检查和调查，以确定可能影响LDLT后死亡率的风险因素。
确定可能影响LDLT受体死亡率的术前、术中和术后因素。
123例。
单因素分析中增加早期死亡率的术前因素包括终末期肝病模型（MELD）评分较高、移植物-受体重量比（GRWR）较低、供体年龄较大和复发性自发性细菌性腹膜炎。术中因素包括更多单位的输血、血浆、血小板和冷沉淀、冷缺血和热缺血时间较长以及无肝期较长等。术后因素包括重症监护病房（ICU）或住院时间较长以及术后实验室数据异常。在最终的逻辑回归模型中，最显著的因素是术前GRWR、住院时间、术中输血量、术后丙氨酸转氨酶、术后总白细胞计数和MELD评分。
通过尝试解决已被确定为LDLT后早期死亡率促成因素的临床因素，可能会改善LDLT的结果。
早期死亡率预测因素的分析应纳入更多风险因素，如与患者门静脉血流动力学相关的因素。
无。
