Hou Shan-Sheng, Liu Jun, Qiao Peng-Fei, Yang Dong-Ge, Huang Liang-Fei, Liu Fei, Liu Yue, Jia Ting-Ting, Wang Hong-Liang
Department of Organ Transplantation, The 923 Hospital of PLA Joint Logistic Support Force, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
Organ Transplantation Research Institute, The Second Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
World J Psychiatry. 2025 Jul 19;15(7):104812. doi: 10.5498/wjp.v15.i7.104812.
Postoperative delirium (POD) is a concerning complication of organ transplantation. With organ transplantation offering hope to patients with end-stage organ disease, understanding the incidence and risk factors of POD is crucial, as it can significantly affect patients' prognosis and healthcare costs.
To systematically evaluate the incidence and risk factors of POD following organ transplantation to facilitate clinical prevention and optimize patient management and prognosis.
Multiple databases such as PubMed and their reference lists were comprehensively searched using a combination of keywords related to organ transplantation and POD. Relevant observational studies on patients who had undergone solid organ transplantation and randomized controlled trials containing relevant analyses were included. Duplicated, data-deficient, non-English, and non-original data studies were excluded. Data were extracted independently by two researchers and then cross-checked. The Newcastle-Ottawa scale was used to evaluate the quality of the included studies. RevMan 5.3 was employed for data analysis. The pooled incidence of POD was calculated according to the data type, and the fixed or random effect model was employed to analyze risk factors based on heterogeneity. Subsequently, sensitivity analysis and publication bias assessments were performed.
A total of 39 relevant literatures were included. The overall incidence of POD in the organ transplant group was 20% [95% confidence interval (CI): 18%-22%]; liver transplant group, 22% (95%CI: 17%-26%); lung transplant group, 34% (95%CI: 23%-45%); and kidney transplant group, 6% (95%CI: 2%-10%). Primary graft dysfunction increased the POD risk, with a pooled odds ratio (OR) (95%CI) of 1.78 (1.09-2.91). A history of hepatic encephalopathy increased the POD risk, with a pooled OR (95%CI) of 3.19 (2.30-4.43). The higher the Acute Physiology and Chronic Health Evaluation II score, the greater the POD risk, with a pooled OR (95%CI) of 1.52 (1.09-2.12). A history of alcohol abuse increased the POD risk, with a pooled OR (95%CI) of 2.84 (1.74-4.65). Thus, the higher the model for end-stage liver disease score, the greater the POD risk, with a pooled OR (95%CI) of 2.49 (1.14-5.43). POD was more likely to develop in patients with preoperative infections, with a pooled OR (95%CI) of 2.78 (1.56-4.97). The use of diuretics increased the POD risk, with a pooled OR (95%CI) of 2.36 (1.38-4.04).
In this study, the overall incidence of POD in patients who underwent organ transplantation is 20%. The incidence varies among different types of organ transplantation, and multiple factors can increase the POD risk.
术后谵妄（POD）是器官移植中一个令人担忧的并发症。随着器官移植为终末期器官疾病患者带来希望，了解POD的发生率和风险因素至关重要，因为它会显著影响患者的预后和医疗成本。
系统评估器官移植后POD的发生率和风险因素，以促进临床预防并优化患者管理及预后。
使用与器官移植和POD相关的关键词组合，全面检索多个数据库，如PubMed及其参考文献列表。纳入对接受实体器官移植患者的相关观察性研究以及包含相关分析的随机对照试验。排除重复、数据不足、非英文和非原始数据研究。由两名研究人员独立提取数据，然后进行交叉核对。使用纽卡斯尔-渥太华量表评估纳入研究的质量。采用RevMan 5.3进行数据分析。根据数据类型计算POD的合并发生率，并基于异质性采用固定或随机效应模型分析风险因素。随后进行敏感性分析和发表偏倚评估。
共纳入39篇相关文献。器官移植组中POD的总体发生率为20%[95%置信区间（CI）：18%-22%]；肝移植组为22%（95%CI：17%-26%）；肺移植组为34%（95%CI：23%-45%）；肾移植组为6%（95%CI：2%-10%）。原发性移植物功能障碍增加了POD风险，合并比值比（OR）（95%CI）为1.78（1.09-2.91）。肝性脑病病史增加了POD风险，合并OR（95%CI）为3.19（2.30-4.43）。急性生理与慢性健康状况评估II评分越高，POD风险越大，合并OR（95%CI）为1.52（1.09-2.12）。酗酒史增加了POD风险，合并OR（95%CI）为2.84（1.74-4.65）。因此，终末期肝病评分越高，POD风险越大，合并OR（95%CI）为2.49（1.14-5.43）。术前有感染的患者更易发生POD，合并OR（95%CI）为2.78（1.56-4.97）。使用利尿剂增加了POD风险，合并OR（95%CI）为2.36（1.38-4.04）。
在本研究中，接受器官移植患者中POD的总体发生率为20%。不同类型器官移植的发生率有所不同，多种因素可增加POD风险。
