Chang Wei-Jung, Hsieh Chia-En, Hung Yu-Ju, Hsu Ya-Lan, Lin Kuo-Hua, Chen Yao-Li
From the Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.
Exp Clin Transplant. 2022 Aug;20(8):750-756. doi: 10.6002/ect.2022.0199.
History of alcohol abuse is a predictive factor for posttransplant delirium. We aimed to investigate whether preoperative abstinence was associated with posttransplant delirium in liver transplant recipients with alcohol-related cirrhosis.
From January 2014 to December 2019, 84 patients with alcohol-related cirrhosis who received living donor liver transplant were retrospectively reviewed and divided into a delirium group (n = 46, 54.8%) and a nondelirium group (n = 38, 45.2%) using the Richmond Agitation- Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit.
In the delirium group versus the nondelirium group, patients were more likely to have preoperative hepatic encephalopathy (58.7% vs 31.6%; P = .013), more likely to have higher Model for End-Stage Liver Disease scores (27.05 ± 10.56 vs 18.85 ± 7.96; P < .001), less likely to have preoperative alcohol abstinence (43.5% vs 68.4%%; P = .022), had longer duration of mechanical ventilation (7.57 ± 7.82 vs 2.50 ± 5.96 days; P = .001), and had longer stays in the intensive care unit (14.85 ± 15.01 vs 8.84 ± 7.84 days; P = .021) and in the hospital (37.89 ± 18.85 vs 27.15 ± 10.43 days; P = .002). Multivariate analysis revealed that preoperative alcohol abstinence (odds ratio 4.953; 95% CI, 1.519-16.152; P = .008) was a significant predictor and that more patients had abstinence durations <3 months (60.9% vs 34.2%; P = .048) in the delirium group.
A high incidence of posttransplant delirium in liver transplant recipients with alcohol- related cirrhosis was associated with preoperative abstinence. Abstinence >6 months before living donor liver transplant is suggested to reduce the risk of posttransplant delirium.
酗酒史是移植后谵妄的一个预测因素。我们旨在调查术前戒酒是否与酒精性肝硬化肝移植受者的移植后谵妄有关。
回顾性分析2014年1月至2019年12月期间接受活体肝移植的84例酒精性肝硬化患者，并使用里士满躁动镇静量表和重症监护病房意识模糊评估方法将其分为谵妄组（n = 46，54.8%）和非谵妄组（n = 38，45.2%）。
与非谵妄组相比，谵妄组患者术前更易发生肝性脑病（58.7% 对31.6%；P = 0.013），终末期肝病模型评分更高（27.05±10.56对18.85±7.96；P < 0.001），术前戒酒的可能性更小（43.5% 对68.4%；P = 0.022），机械通气时间更长（7.57±7.82对2.50±5.96天；P = 0.001），在重症监护病房的停留时间更长（14.85±15.01对8.84±7.84天；P = 0.021），住院时间更长（37.89±18.85对27.15±10.43天；P = 0.002）。多因素分析显示，术前戒酒（比值比4.953；95%可信区间，1.519 - 16.152；P = 0.008）是一个显著的预测因素，且谵妄组中戒酒时间<3个月的患者更多（60.9% 对34.2%；P = 0.048）。
酒精性肝硬化肝移植受者移植后谵妄的高发生率与术前戒酒有关。建议在活体肝移植前戒酒>6个月以降低移植后谵妄的风险。
