原位肝移植早期肝功能不良危险因素80例分析  

Clinic risk factors resulting in initial poor graft function after orthotopic liver transplantation:an analysis of 80 cases

作　　者：陈皓[1] 彭承宏[1] 沈柏用[1] 申川[1] 邓侠兴[1] 周光文[1] 谢俊杰[1] 董卫[1] 李宏为[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院器官移植中心,200025

出　　处：《中国实用外科杂志》2005年第12期727-729,共3页Chinese Journal of Practical Surgery

基　　金：上海市科委基金资助(基金编号O14119002)

摘　　要：目的分析原位肝移植后导致移植肝初期肝功能不良(initial poor graft function,IPGF)的各种临床因素。方法回顾性分析上海交通大学医学院附属瑞金医院器官移植中心2002年6月至2004年12月80例原位肝移植的病例资料。肝移植术后72h内血清谷氨酸转氨酶(ALT)和(或)天冬氨酸转氨酶(AST)≥1500IU/L作为IPGF组,<1500IU/L作为非IPGF组。受体术前分析指标为:年龄、性别、原发疾病、Child-Pugh分级。围手术期分析指标为:心脏停搏时间(NHBT)、冷缺血时间(CIT)、供肝复温缺血时间(RWIT)、冷保存末期肝活检和术后72h内ALT和AST值。通过Logistic回归模型筛选出有可能引发IPGF的危险因素。结果NHBT、CIT、RWITIPGF组显著高于非IPGF组(P<0·05);Logistic回归模型显示NHBT是引发IPGF的危险因素(P<0·05),CIT、RWIT是可能的潜在危险因素。IPGF组中1例中度大泡脂肪变性供肝移植后出现PGNF。结论NHBT延长是引起IPGF的主要危险因素,供肝脂肪变性、CIT、RWIT延长可能是潜在危险因素。Objective To establish the clinic risk factors resulting in initial poor graft function （IPGF） after orthotopic liver transplantation （OLT）. Methods Eighty cases of orthotopic liver transplantation admitted between June 2002 and December 2004 in Ruijin Hospital of Shanghai Jiao Tong University were analyzed retrospectively. The group of IPGF was confirmed if alanineaminotransferase （ALT） and/or aspartate aminotransferase （AST） was above 1500 IU/L within 72 hours after OLT while non IPGF group below 1500 IU/L. Recipient associated factors before OLT analyzed were age, sex, primary liver diseases and Child-Pugh＇ s classification. Factors analyzed with peri-operative period were non-heart bearting time （NHBT）, cold preservation time （CIT）, warm ischemic time （RWIT）, liver biopsy at the end of cold ischemia and ALT and/or AST within 72 hours after OLT. Logistic regression model was applied to filter the possible factors resulting in IPGF. Results Donor NHBT, CIT and RWIT were longer significantly in IPGF group than non IPGF group （P〈0.05）. In logistic regression model, NHBT was the risk factor leading to IPGF （P〈0.05） while CIT, RWIT were the possible risk factors. In one case of IPGF group PGNF was appeared with moderate hepatic steatosis. Conclusion NHBT is an important risk factor leading to IPGF while steatosis in donor liver. CIT and RWIT are potential risk factors.

关 键 词：原位肝移植 肝功能不良 

分 类 号：R6[医药卫生—外科学]