肝移植术后肺部并发症的术中影响因素。

Intraoperative Factors Modifying the Risk of Postoperative Pulmonary Complications After Living Donor Liver Transplantation.

机构信息

Department of Anesthesiology and Pain Medicine, Gwangmyeong Hospital, Chung-Ang University School of Medicine, Gwangmyeong, Korea.

Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

出版信息

Transplantation. 2023 Aug 1;107(8):1748-1755. doi: 10.1097/TP.0000000000004544. Epub 2023 Mar 24.

DOI:10.1097/TP.0000000000004544

PMID:36959123

Abstract

BACKGROUND

The relationship between intraoperative anesthetic management and postoperative pulmonary complications (PPCs) after liver transplantation is not fully understood. We aimed to determine the intraoperative contributors to PPC.

METHODS

The retrospectively collected cohort included 605 patients who underwent living donor liver transplantation. PPCs comprised respiratory failure, respiratory infection, pulmonary edema, atelectasis (at least moderate degree), pneumothorax, and pleural effusion (at least moderate degree). The presence and type of PPC were evaluated by 2 pulmonary physicians. Logistic regression analysis was performed to determine the association between perioperative variables and PPC risk.

RESULTS

Of the 605 patients, 318 patients (52.6%) developed 486 PPCs. Multivariable analysis demonstrated that PPC risk decreased with low tidal volume ventilation (odds ratio [OR] 0.62 [0.41-0.94], P = 0.023) and increased with greater driving pressure at the end of surgery (OR 1.08 [1.01-1.14], P = 0.018), prolonged hypotension (OR 1.85 [1.27-2.70], P = 0.001), and blood albumin level ≤3.0 g/dL at the end of surgery (OR 2.43 [1.51-3.92], P < 0.001). Survival probability at 3, 6, and 12 mo after transplantation was 91.2%, 89.6%, and 86.5%, respectively, in patients with PPCs and 98.3%, 96.5%, and 93.4%, respectively, in patients without PPCs (hazard ratio 2.2 [1.3-3.6], P = 0.004). Graft survival probability at 3, 6, and 12 mo after transplantation was 89.3%, 87.1%, and 84.3%, respectively, in patients with PPCs and 97.6%, 95.8%, and 92.7%, respectively, in patients without PPCs (hazard ratio 2.3 [1.4-3.7], P = 0.001).

CONCLUSIONS

We found that tidal volume, driving pressure, hypotension, and albumin level during living donor liver transplantation were significantly associated with PPC risk. These data may help determine patients at risk of PPC or develop an intraoperative lung-protective strategy for liver transplant recipients.

摘要

背景

肝移植术后围手术期麻醉管理与肺部并发症（PPC）之间的关系尚未完全阐明。我们旨在确定 PPC 的术中相关因素。

方法

本回顾性队列研究纳入了 605 例行活体供肝移植的患者。PPC 包括呼吸衰竭、呼吸感染、肺水肿、肺不张（至少中度）、气胸和胸腔积液（至少中度）。由 2 位肺部医生评估 PPC 的存在和类型。采用多变量逻辑回归分析来确定围手术期变量与 PPC 风险之间的关联。

结果

在 605 例患者中，318 例（52.6%）发生了 486 例 PPC。多变量分析表明，PPC 风险随低潮气量通气（比值比 [OR] 0.62 [0.41-0.94]，P = 0.023）降低而随手术结束时较高的驱动压（OR 1.08 [1.01-1.14]，P = 0.018）、低血压持续时间延长（OR 1.85 [1.27-2.70]，P = 0.001）和手术结束时血清白蛋白水平≤3.0 g/dL（OR 2.43 [1.51-3.92]，P < 0.001）而增加。移植后 3、6 和 12 个月时，有 PPC 的患者的生存率分别为 91.2%、89.6%和 86.5%，而无 PPC 的患者的生存率分别为 98.3%、96.5%和 93.4%（风险比 2.2 [1.3-3.6]，P = 0.004）。移植后 3、6 和 12 个月时，有 PPC 的患者的移植物存活率分别为 89.3%、87.1%和 84.3%，而无 PPC 的患者的移植物存活率分别为 97.6%、95.8%和 92.7%（风险比 2.3 [1.4-3.7]，P = 0.001）。