公民逝世后器官捐献供肝移植术后早期肝功能障碍的危险因素。

Risk factors of early liver dysfunction after liver transplantation using grafts from donation after citizen death donors.

机构信息

Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China.

出版信息

Transpl Immunol. 2022 Apr;71:101525. doi: 10.1016/j.trim.2021.101525. Epub 2022 Jan 3.

DOI:10.1016/j.trim.2021.101525

PMID:34990790

Abstract

BACKGROUND

As an early complication after liver transplantation, early allograft dysfunction (EAD) indicates a poor prognosis. This study analyzes the risk factors related to early allograft dysfunction (EAD) after liver transplantation using grafts from donation after citizen death (DCD) to provide a reference for the prevention of EAD after DCD liver transplantation.

METHODS

A total of 32 patients who underwent DCD liver transplantation in the organ transplantation center of our hospital from September 2013 to January 2021 were enrolled in this study. The patients were divided into the EAD group and non-EAD group according to whether they developed EAD after transplantation. The general data of the donors and recipients before transplantation, intraoperative conditions, and clinical data within one week after transplantation were compared between the two groups, and related complications were statistically analyzed. The follow-up time was one week postoperatively or, if they died within the first week postoperatively, until the patient died.

RESULTS

The subjects included 10 females and 22 males, and the incidence of postoperative EAD was 25% (8/32). Four patients (12%) had primary malignant tumors (primary liver cancer and cholangiocarcinoma), and five donors (15%) had fatty liver. The univariate analysis revealed that the donor BMI (P = 0.005), degree of fatty liver (P = 0.025), aspartate aminotransferase (P = 0.001), alanine aminotransferase (P < 0.001), and total bilirubin (P = 0.009) were related to the occurrence of EAD after DCD liver transplantation. By analyzing the correlation between the incidence EAD and postoperative complications after liver transplantation using grafts from DCD donors, it was shown that the incidence of primary nonfunction (PNF) is related to EAD (P = 0.024).

CONCLUSION

Donor BMI, the degree of fatty liver, and preoperative liver function are risk factors for EAD after DCD liver transplantation, and the occurrence of EAD after DCD liver transplantation significantly increases the probability of PNF.

摘要

背景

早期移植物功能障碍（EAD）是肝移植后的早期并发症，提示预后不良。本研究分析了公民逝世后器官捐献（DCD）供肝移植后发生早期移植物功能障碍（EAD）的相关危险因素，为预防 DCD 肝移植后 EAD 提供参考。

方法

选取 2013 年 9 月至 2021 年 1 月在我院器官移植中心行 DCD 肝移植术的 32 例患者，根据术后是否发生 EAD 将患者分为 EAD 组和非 EAD 组。比较两组患者术前一般资料、术中情况及术后 1 周内临床资料，统计相关并发症。随访时间为术后 1 周，若术后 1 周内死亡，则随访至患者死亡。

结果

共纳入 10 例女性和 22 例男性患者，术后 EAD 发生率为 25%（8/32）。4 例患者（12%）患有原发性恶性肿瘤（原发性肝癌和胆管细胞癌），5 例供者（15%）患有脂肪肝。单因素分析显示，供者 BMI（P=0.005）、脂肪肝程度（P=0.025）、天门冬氨酸氨基转移酶（P=0.001）、丙氨酸氨基转移酶（P<0.001）和总胆红素（P=0.009）与 DCD 肝移植后 EAD 的发生有关。分析 DCD 供肝移植术后 EAD 与并发症的相关性，发现原发性无功能（PNF）发生率与 EAD 相关（P=0.024）。