肝移植后再灌注综合征：结局、预测因素及其在受体选择中的应用。

Postreperfusion syndrome in liver transplantation: Outcomes, predictors, and application for recipient selection.

机构信息

Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

Division of General Surgery, Department of Surgery, Mount Sinai School of Medicine, New York City, New York, USA.

出版信息

Clin Transplant. 2022 Apr;36(4):e14587. doi: 10.1111/ctr.14587. Epub 2022 Jan 19.

DOI:10.1111/ctr.14587

PMID:34997798

Abstract

BACKGROUND

This study aimed to identify risk factors for postreperfusion syndrome (PRS) and its impact on LT outcomes.

METHODS

Data analysis was performed in 1021 adult patients undergoing donation after brain death (DBD) LT to identify PRS incidence, the risk factors for PRS development, and its impact on LT outcomes.

RESULTS

The overall incidence of PRS was 16.1%. Independent risk factors for PRS included donor age (odds ratio (OR) 1.01, P = .02), donor body mass index (BMI) (OR 1.04, P = .003), moderate macrosteatosis (OR 2.48, P = .02), and cold ischemia time (CIT) (OR 1.06, P = .02). On multivariable analysis for 30-day graft failure, PRS (hazard ratio (HR) 3.49; P < .001) and Model for End-stage Liver Disease (MELD) score (HR 1.01; P = .05) were independent risk factors. Patients were categorized into four distinct groups based on PRS risk groups and MELD groups, which showed different 1-year graft survival (P < .001). There were comparable outcomes between low PRS risk - high MELD and high PRS risk - low MELD group (P = .33).

CONCLUSIONS

Donor age, donor BMI, moderate macrosteatosis, and CIT were identified as risk factors for the development of PRS in LT using DBD grafts. PRS risk evaluation may improve donor-to-recipient matching based on their MELD scores.

摘要

背景

本研究旨在确定再灌注后综合征（PRS）的风险因素及其对肝移植（LT）结局的影响。

方法

对 1021 例接受脑死亡供体（DBD）LT 的成年患者进行数据分析，以确定 PRS 的发生率、PRS 发展的危险因素及其对 LT 结局的影响。

结果

PRS 的总体发生率为 16.1%。PRS 的独立危险因素包括供体年龄（比值比（OR）1.01，P =.02）、供体体重指数（BMI）（OR 1.04，P =.003）、中度脂肪变性（OR 2.48，P =.02）和冷缺血时间（CIT）（OR 1.06，P =.02）。在 30 天移植物失败的多变量分析中，PRS（风险比（HR）3.49；P <.001）和终末期肝病模型（MELD）评分（HR 1.01；P =.05）是独立的危险因素。根据 PRS 风险组和 MELD 组，患者分为四个不同的组，显示出不同的 1 年移植物存活率（P <.001）。低 PRS 风险-高 MELD 与高 PRS 风险-低 MELD 组之间的结果相似（P =.33）。