无缺血肝移植减轻移植后心肌损伤和肺部并发症：来自IFLT-DBD试验的事后分析

Ischemia-free liver transplantation alleviates post-transplant myocardial injury and pulmonary complication: a post hoc analysis from IFLT-DBD trial.

作者信息

Shen Yuekun, Dong Yuqi, Yang Bing, Chen Xiaoxiang, Xiong Wei, Zhang Tao, Chen Maogen, Zhao Qiang, Ju Weiqiang, Hu Anbin, Wang Dongping, Guo Zhiyong, Yang Lu, He Xiaoshun

机构信息

Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

出版信息

Int J Surg. 2025 Jun 4. doi: 10.1097/JS9.0000000000002591.

DOI:10.1097/JS9.0000000000002591

PMID:40465772

Abstract

BACKGROUND

Ischemia-free liver transplantation (IFLT) prevents ischemia-reperfusion injury (IRI) and reduces IRI-related complications. In this study, we explored the protective effects of IFLT on myocardial injury after noncardiac surgery (MINS) and postoperative pulmonary complications (PPCs).

MATERIALS AND METHODS

Sixty-five patients who underwent liver transplantation were enrolled in this post hoc analysis of the IFLT-DBD trial. Intraoperative pulse indicator continuous cardiac output, pulmonary artery catheter, and blood gas parameters were prospectively collected.

RESULTS

The incidence of MINS did not differ between the two groups (28.1% vs. 45.5%, P = 0.147), although the peak high-sensitive troponin level was significantly lower in the IFLT group than in the conventional liver transplantation (CLT) group (0.056 ± 0.007 vs. 0.088 ± 0.016 ng/mL, P = 0.036). The incidence of PPCs was lower in the IFLT group than in the CLT group (37.5% vs. 66.7%, P = 0.019). Multivariate analysis revealed that IFLT was an independent protective factor against PPC. The median duration of ventilation was significantly shorter in the IFLT group than in the CLT group [12.5 (3.5-21.5) vs. 18 (0-69.5) hours, P<0.001].

CONCLUSION

The use of IFLT is associated with lower peak troponin T level and lower incidence of PPC.

摘要

背景

无缺血肝移植（IFLT）可预防缺血再灌注损伤（IRI）并减少与IRI相关的并发症。在本研究中，我们探讨了IFLT对非心脏手术（MINS）后心肌损伤和术后肺部并发症（PPCs）的保护作用。

材料与方法

65例行肝移植的患者纳入了IFLT-DBD试验的这项事后分析。前瞻性收集术中脉搏指示连续心输出量、肺动脉导管和血气参数。

结果

两组间MINS的发生率无差异（28.1%对45.5%，P = 0.147），尽管IFLT组的高敏肌钙蛋白峰值水平显著低于传统肝移植（CLT）组（0.056±0.007对0.088±0.016 ng/mL，P = 0.036）。IFLT组的PPCs发生率低于CLT组（37.5%对66.7%，P = 0.019）。多因素分析显示IFLT是预防PPC的独立保护因素。IFLT组的中位通气时间显著短于CLT组[12.5（3.5 - 21.5）对18（0 - 69.5）小时，P<0.001]。