受者的热缺血时间延长与活体肝移植后移植后胆管狭窄有关。

Prolonged warm ischemia time in the recipient is associated with post-transplant biliary stricture following living-donor liver transplantation.

机构信息

Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.

出版信息

Surg Today. 2024 Oct;54(10):1193-1200. doi: 10.1007/s00595-024-02823-z. Epub 2024 Mar 13.

DOI:10.1007/s00595-024-02823-z

PMID:38478124

Abstract

PURPOSE

Post-transplant biliary stricture (PBS) is a common and important complication following orthotopic liver transplantation (LT). This study clarified the incidence of PBS and identified its risk factors.

METHODS

We retrospectively reviewed the medical records of 67 patients who underwent living-donor LT (LDLT) at our institute between June 2010 and July 2022 and analyzed their clinical characteristics, prognosis, and risk factors for PBS.

RESULTS

Of the 67 patients, 26 (38.8%) developed PBS during the observation period. Multivariate analyses revealed the following independent risk factors for PBS formation: increased red cell transfusion volume per body weight (> 0.2 U/kg; hazard ratio [HR], 3.8; P = 0.002), increased portal vein pressure (PVP) at the end of LT (> 16 mmHg; HR, 2.88; P = 0.032), postoperative biliary leakage (HR, 4.58; P = 0.014), and prolonged warm ischemia time (WIT) (> 48 min; HR, 4.53; P = 0.008). In patients with PBS, the cumulative incidence of becoming stent free was significantly higher in patients with a WIT ≤ 48 min than in those with a WIT > 48 min (P = 0.038).

CONCLUSION

Prolonged WIT is associated with intractable PBS following LDLT.

摘要

目的

移植后胆道狭窄（PBS）是肝移植（LT）后常见且重要的并发症。本研究阐明了 PBS 的发生率，并确定了其危险因素。

方法

我们回顾性分析了 2010 年 6 月至 2022 年 7 月期间在我院接受活体供肝 LT（LDLT）的 67 例患者的病历，并分析了他们的临床特征、预后以及 PBS 的危险因素。

结果

在观察期间，67 例患者中有 26 例（38.8%）发生了 PBS。多变量分析显示，PBS 形成的独立危险因素包括：体重增加的红细胞输注量（>0.2 U/kg；风险比 [HR]，3.8；P=0.002）、LT 结束时门静脉压（PVP）升高（>16mmHg；HR，2.88；P=0.032）、术后胆漏（HR，4.58；P=0.014）和热缺血时间（WIT）延长（>48 分钟；HR，4.53；P=0.008）。在 PBS 患者中，WIT≤48 分钟的患者无支架累积发生率明显高于 WIT>48 分钟的患者（P=0.038）。