近期发生自发性细菌性腹膜炎的活体肝移植受者的结局。
The outcome of living donor liver transplant recipients with recent episodes of spontaneous bacterial peritonitis.
机构信息
Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, India.
出版信息
Rev Esp Enferm Dig. 2021 Apr;113(4):251-254. doi: 10.17235/reed.2020.6780/2019.
BACKGROUND
spontaneous bacterial peritonitis (SBP) is a common complication in patients with cirrhosis and is associated with a high mortality rate. Only a few reports have analyzed the impact of treated SBP that occurs in the immediate pre-operative period on outcome after a living donor liver transplantation (LDLT). The results of whether post-transplant patients are dependent on pre-transplant infections are still debatable and unclear. Therefore, this study examined the outcomes of LDLT recipients with recent episodes of SBP and LDLT recipients without prior episodes of SBP.
PATIENTS
the records of 62 LDLT recipients who underwent LDLT were retrospectively reviewed. Twenty-four (36 %) recipients had at least one episode of SBP before LDLT. However, active SBP was not present in any of the recipients at the time of LDLT. Both recipient groups were compared in terms of demographic profile, perioperative and postoperative variables and outcomes.
RESULTS
higher pre-operative Child-Turcotte-Pugh (CTP) score (mean [SD] 11.77 [1.37] vs 10.5 [1.22], p < 0.001) and prior history of renal dysfunction (mean serum creatinine [SD] 1.715 [1.08] vs 1.02 [0.479] mg/dl, p = 0.002) were more commonly associated with the SBP group as compared to the non-SBP group. However, there was no statistically significant difference between the two groups in terms of the following variables: previous diabetes mellitus (3 [12.5 %] vs 6 [15.8 %]), pre-operative model for end-stage liver disease (MELD) score (median [IQR] 21 [10-37] vs 22 [9-39]), operative time (mean [SD] 789.57 [153.49] vs 800.86 [138.69] min), total number of blood transfusion (median [IQR] 10 [2-19] vs 8 [1-18]), hospital stay (median 21 vs 20 days), re-exploration (4 [16.6 %] vs 2 [5.3 %]), postoperative sepsis (8 [33 %] vs 5 [13 %]) and 30-day mortality (3 [12.5 %] vs 2 [5.3 %]).
CONCLUSIONS
the presence of previous episodes of pre-operative SBP in LDLT recipients does not result in adverse post-operative short-term outcomes.
背景
自发性细菌性腹膜炎（SBP）是肝硬化患者的常见并发症，与高死亡率相关。仅有少数研究分析了肝移植前即刻发生的治疗性 SBP 对活体供肝移植（LDLT）后结局的影响。关于移植后患者是否依赖于移植前感染的结果仍存在争议，尚不清楚。因此，本研究分析了近期发生 SBP 的 LDLT 受者和无既往 SBP 发作的 LDLT 受者的结局。
患者
回顾性分析了 62 例接受 LDLT 的 LDLT 受者的记录。24 例（36%）受者在 LDLT 前至少有一次 SBP 发作。然而，在 LDLT 时，没有任何受者存在活动性 SBP。比较两组受者的人口统计学特征、围手术期和术后变量及结局。
结果
SBP 组受者术前 Child-Turcotte-Pugh（CTP）评分较高（平均[标准差] 11.77[1.37] vs 10.5[1.22]，p＜0.001），且既往肾功能障碍更为常见（平均血清肌酐[标准差] 1.715[1.08] vs 1.02[0.479]mg/dl，p=0.002）。然而，两组在以下变量方面无统计学差异：既往糖尿病（3[12.5%] vs 6[15.8%]）、术前终末期肝病模型（MELD）评分（中位数[IQR]21[10-37] vs 22[9-39]）、手术时间（平均[标准差]789.57[153.49] vs 800.86[138.69]min）、总输血量（中位数[IQR]10[2-19] vs 8[1-18]）、住院时间（中位数 21 天 vs 20 天）、再次探查（4[16.6%] vs 2[5.3%]）、术后败血症（8[33%] vs 5[13%]）和 30 天死亡率（3[12.5%] vs 2[5.3%]）。
结论
LDLT 受者术前存在既往 SBP 发作不会导致术后短期不良结局。
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