分析与肝移植中预测肝重与实际肝重之间差异相关的因素。

Analysis of factors associated with discrepancies between predicted and observed liver weight in liver transplantation.

机构信息

Hepato-Pancreato-Biliary Surgery and Liver transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.

ICube, Université de Strasbourg, CNRS UMR 7357, Illkirch, France.

出版信息

Liver Int. 2021 Jun;41(6):1379-1388. doi: 10.1111/liv.14819. Epub 2021 Mar 1.

DOI:10.1111/liv.14819

PMID:33555130

Abstract

BACKGROUND

Even using predictive formulas based on anthropometrics in about 30% of subjects, liver weight (LW) cannot be predicted with a ≤20% margin of error. We aimed to identify factors associated with discrepancies between predicted and observed LW.

METHODS

In 500 consecutive liver grafts, we tested LW predictive performance using 17 formulas based on anthropometric characteristics. Hashimoto's formula (961.3 × BSA_D-404.8) was associated with the lowest mean absolute error and used to predict LW for the entire cohort. Clinical factors associated with a ≥20% margin of error were identified in a multivariable analysis after propensity score matching (PSM) of donors with similar anthropometric characteristics.

RESULTS

The total LW was underestimated with a ≥20% margin of error in 53/500 (10.6%) donors and overestimated in 62/500 (12%) donors. After PSM analysis, ages ≥ 65, (OR = 3.21; CI95% = 1.63-6.31; P = .0007), age ≤ 30 years, (OR = 2.92; CI95% = 1.15-7.40; P = .02), and elevated gamma-glutamyltransferase (GGT) levels (OR = 0.98; CI95% = 0.97-0.99; P = .006), influenced the risk of LW overestimation. Age ≥ 65 years, (OR = 5.98; CI95% = 2.28-15.6; P = .0002), intensive care unit (ICU) stay with ventilation > 7 days, (OR = 0.32; CI95% = 0.12-0.85; P = .02) and waist circumference increase (OR = 1.02; CI95% = 1.00-1.04; P = .04) were factors associated with LW underestimation.

CONCLUSIONS

Increased waist circumference, age, prolonged ICU stay with ventilation, elevated GGT were associated with an increase in the margin of error in LW prediction. These factors and anthropometric characteristics could help transplant surgeons during the donor-recipient matching process.

摘要

背景

即使在大约 30%的受试者中使用基于人体测量学的预测公式，肝重量（LW）也无法以≤20%的误差幅度进行预测。我们旨在确定与预测 LW 和实际 LW 之间差异相关的因素。

方法

在 500 例连续肝移植供体中，我们使用基于人体测量特征的 17 种公式来测试 LW 预测性能。桥本公式（961.3×BSA_D-404.8）与最低平均绝对误差相关，用于预测整个队列的 LW。在对具有相似人体测量特征的供体进行倾向评分匹配（PSM）后，在多变量分析中确定了与≥20%误差幅度相关的临床因素。

结果

在 500 例供体中，有 53 例（10.6%）供体的总 LW 被低估≥20%，有 62 例（12%）供体的总 LW 被高估。在 PSM 分析后，年龄≥65 岁（OR=3.21；95%CI=1.63-6.31；P=0.0007）、年龄≤30 岁（OR=2.92；95%CI=1.15-7.40；P=0.02）和γ-谷氨酰转移酶（GGT）水平升高（OR=0.98；95%CI=0.97-0.99；P=0.006）会增加 LW 高估的风险。年龄≥65 岁（OR=5.98；95%CI=2.28-15.6；P=0.0002）、入住重症监护病房（ICU）并机械通气>7 天（OR=0.32；95%CI=0.12-0.85；P=0.02）和腰围增加（OR=1.02；95%CI=1.00-1.04；P=0.04）是与 LW 低估相关的因素。