From the Department of Liver Transplant, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Exp Clin Transplant. 2022 Jul;20(7):668-673. doi: 10.6002/ect.2022.0079.
Hepatitis B virus-related acute-on-chronic liver failure remains a life-threatening syndrome, and transplant is the definitive treatment. Early allograft dysfunction is a postoperative complication and affects morbidity and mortality. We studied the risk factors associated with early allograft dysfunction in livertransplantrecipients with hepatitis B virus-related acute-on-chronic liver failure.
This single-center retrospective study of early allograft dysfunction is based on data from January 2015 to June 2020 for 323 recipients with hepatitis B virus-related acute-on-chronic liver failure and 445 with only hepatitis B virus infection (control group). Data that correlated with early allograft dysfunction and outcome were analyzed.
Incidence of early allograft dysfunction in patients with hepatitis B virus-related acute-on-chronic liver failure was significantly higher versus the control group (39.3% vs 21.1%; P < .001). Transplant recipients with hepatitis B virus-related acute-onchronic liver failure who developed early allograft dysfunction had lower 90-day, 180-day, and 360-day patient survival rates versus patients with no early allograft dysfunction (89.0% vs 98.0%, 82.7% vs 97.5%, and 80.3% vs 96.4%, respectively; P < .001). Pretransplant kidney failure (odds ratio, 2.644; 95% CI, 1.019-6.864; P = .046), pretransplant coagulation failure (odds ratio, 2.162; 95% CI, 1.291-3.621; P = .003), and operative time (odds ratio, 1.005; 95% CI, 1.002-1.008; P = .003) were independent risk factors for early allograft dysfunction in liver transplant recipients with hepatitis B virus-related acute-onchronic liver failure. There was a synergistic effect of early allograft dysfunction and preoperative kidney/coagulation failure on survival rates of liver transplant recipients with hepatitis B virus-related acute-on-chronic liver failure.
Preoperative kidney/coagulation failure and operative time were independent risk factors of early allograft dysfunction in deceased donor liver transplant recipients with hepatitis B virus-related acute-on-chronic liver failure. The combination of early allograft dysfunction and preoperative kidney/coagulation failure was significantly associated with lower survival of these recipients.
乙型肝炎病毒相关慢加急性肝衰竭仍然是一种危及生命的综合征，肝移植是其明确的治疗方法。早期移植物功能障碍是一种术后并发症，影响发病率和死亡率。我们研究了与乙型肝炎病毒相关慢加急性肝衰竭肝移植受者早期移植物功能障碍相关的危险因素。
这项关于早期移植物功能障碍的单中心回顾性研究基于 2015 年 1 月至 2020 年 6 月期间 323 例乙型肝炎病毒相关慢加急性肝衰竭患者和 445 例仅乙型肝炎病毒感染患者（对照组）的数据。分析了与早期移植物功能障碍和结局相关的数据。
乙型肝炎病毒相关慢加急性肝衰竭患者早期移植物功能障碍的发生率明显高于对照组（39.3%比 21.1%；P<0.001）。与无早期移植物功能障碍的患者相比，发生早期移植物功能障碍的乙型肝炎病毒相关慢加急性肝衰竭肝移植受者的 90 天、180 天和 360 天患者生存率较低（89.0%比 98.0%、82.7%比 97.5%和 80.3%比 96.4%；P<0.001）。移植前肾功能衰竭（比值比，2.644；95%置信区间，1.019-6.864；P=0.046）、移植前凝血功能障碍（比值比，2.162；95%置信区间，1.291-3.621；P=0.003）和手术时间（比值比，1.005；95%置信区间，1.002-1.008；P=0.003）是乙型肝炎病毒相关慢加急性肝衰竭肝移植受者早期移植物功能障碍的独立危险因素。早期移植物功能障碍和术前肾功能/凝血功能障碍对乙型肝炎病毒相关慢加急性肝衰竭肝移植受者的生存率有协同作用。
移植前肾功能/凝血功能障碍和手术时间是乙型肝炎病毒相关慢加急性肝衰竭死亡供肝肝移植受者早期移植物功能障碍的独立危险因素。早期移植物功能障碍和术前肾功能/凝血功能障碍的组合与这些受者的生存率显著降低相关。
