心脏死亡器官捐献肝移植术后早期肝功能不良临床危险因素分析  

Clinical analysis of early allograft dysfunction in patients receiving donation after cardiac death liver Transplantation

作　　者：孙飞[1] 耿磊[1] 章茫里[1] 严盛[1] 王伟林[1] 郑树森[1] 

机构地区：[1]浙江大学医学院附属第一医院肝胆胰外科,杭州310003

出　　处：《中华器官移植杂志》2016年第9期518-521,共4页Chinese Journal of Organ Transplantation

摘　　要：目的研究国际标准化心脏死亡器官捐献（DCD）供肝移植术后受者早期肝功能不全（EAD）的发生情况及其影响因素。方法收集2016年1—5月接受DCD供肝移植的供、受者资料45例，根据受者是否发生EAD分为EAD组和非EAD组，比较两组供、受者的围手术期相关指标，分析EAD发生的危险因素及其对受者短期预后的影响。结果45例中，EAD发生率为57．8％（26例）。随访期内EAD组和非EAD组受者死亡率分别为15．4％和15．8％，差异无统计学意义。EAD组供者年龄、术前谷氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）水平以及冷缺血时间均高于非EAD组，分别为（43．7±2．5）岁和（36．2±2．5）岁（P=0．0409）；（64．2±13．2）U／L和（31．0±5．9）U／L（P=0．0407）；（87．3±16．2）U／L和（48．2±6．2）U／L（P=0．0473）；（629．5±35．2）min和（484．6±30．5）min（P=0．0040）。EAD组受者术前C反应蛋白高于非EAD组，分别为（22．6±5．9）mg／L和（4．7±1．1）mg／L（P=0．0121）；EAD组受者术后血小板水平显著低于非EAD组，分别为（73．7±8．0）×10^9／L和（111．7±16．0）×10^9／L（P=0．0439）。EAD和非EAD组受者术前和术后中性粒细胞与淋巴细胞比值（NLR）的差异无统计学意义。结论供者高龄、术前较高ALT和AST水平、延长的冷缺血时间以及受者术前较高的C反应蛋白水平、术后血小板水平下降是EAD发生的危险因素。Objective To investigate the occurrence and influencing factors of early allograft dysfunction （EAD） in patients receiving donation after cardiac death （DCD） liver Transplantation. Methods Forty-five patients received orthotopic liver transplantation in our center during January 2016 and May 2016 were included in this study. Based on the occurrence of EAD, patients were divided into EAD group and non-EAD group. Perioperative data of donors and recipients were collected to analyze the risk factors of EAD and the effect of EAD on the short-term prognosis of patients. Results In 45 patients, the incidence of EAD was 57. 8% （26 cases）. During the follow-up period, the mortality of recipients in EAD group and non-EAD group was 15.4% and 15.8% respectively, which showed no significant difference. Donor age, preoperative ALT and AST levels, cold isehemia time （CIT） were significantly increased in EAD group than in non-EAD group （43. 7 ＋ 2.5 and 36.2±2.5, P=0.040 9; 64.2±13.2 and 31.0＋5.9, P=0.040 7; 87.3± 16.2 and 48.2±6. 2, P= 0. 047 3; 629. 5± 35. 2 and 484. 6 ± 30. 5, P = 0. 004 0, respectively）. Perioperative CRP level in EAD group was significantly higher than in non-EAD group （22. 6 ± 5. 9 and 4. 7 ±1.1, P = 0. 012 1 ）. What＇s more, postoperative platelet level was significantly lower in EAD group than in non- EAD group （73. 7 ± 8. 0 and 111.7 ± 16. 0, P = 0. 043 9）. However, pre- and post-operative neutrophil-lymphocyte ratio （NLR） in recipients showed no significant difference between EAD group and non-EAD groups. Conclusion Older donor age, high levels of preoperative ALT and AST, prolonged cold ischemic time, as well as high level of preoperative CRP and decrease of postoperative platelet level in recipients are risk factors for the occurrence of EAD after liver transplantation.

关 键 词：肝移植 器官捐献 肝功能不全 

分 类 号：R657.3[医药卫生—外科学]