“中国二类”和“中国三类”供者相关因素对肝移植预后的影响  

Risk assessment of outcomes using grafts from donors after cardiac death

作　　者：陈新国[1] 张庆[1] 尹利华[1] 李威[1] 吴凤东[1] 邹卫龙[1] 王毅[1] 朱雄伟[1] 陈虹[1] 岳扬[1] 邓永林[1] 沈中阳[1] Chen Xinguo Zhang Qing Yin Lihua Li Wei Wu Fengdong Zou Weilong Wang Yi Zhu Xiongwei Chen Hong Yue Yang Deng Yonglin Shen Zhongyang(Institute of Liver Transplantation, General Hospital of Chinese People＇s Armed Police Force, Beijing 100039, China)

机构地区：[1]武警总医院器官移植研究所,北京100039

出　　处：《中华器官移植杂志》2017年第5期287-291,共5页Chinese Journal of Organ Transplantation

基　　金：国家重点基础研究发展计划项目（973计划）（2014CBA02001）

摘　　要：目的 探讨“中国二类”和“中国三类”供者相关因素对肝移植受者预后的影响.方法 回顾性分析2013年9月至2017年1月连续实施的215例“中国二类”和“中国三类”供者供肝移植的临床资料.排除3例术后失随访病例,共211例病例纳入研究.统计供者资料,包括性别、年龄、原发病、体重指数（BMI）、既往病史（脂肪肝、高血压）、重症监护室（ICU）住院时间、机械通气时间、供肝热缺血时间、冷缺血时间、捐献前常规实验室检查指标,采用Kaplan-Meier方法、Log-rank检验及多因素Cox回归方法分析影响受者术后存活的风险因素.结果 211例受者术后6个月、1年和3年总体存活率分别是88％、84％和82％.单因素分析结果显示,供者血清Na＋水平＜136 mmol/L（P=0.018）、供肝冷缺血时间＞9 h（P=0.013）与受者术后存活相关,供者BMI＞30kg/m2（P=0.011）及供者年龄＞60岁（P=0.025）与受者术后并发症有关.多因素分析结果显示,供者血清Na＋水平（P=0.011）是肝移植预后的独立影响因子.结论 筛择合适的供者及控制供者风险因素有助于改善“中国二类”和“中国三类”供者供肝移植的预后.Objective To assess the effects of the risk factors of grafts from donors after cardiac death （DCD） on the prognosis of liver transplantation （LT）.Methods In this retrospectively study,215 cases of LT using DCD donor grafts were performed at our institution from September 2013 to January 2017.Due to the loss to follow-up in 4 cases,211 cases were enrolled in the study.The following DCD donor data were collected：gender,age,primary disease,ABO blood type,body mass index （BMI）,medical history （fatty liver,hypertension）,ICU hospitalization time,mechanical ventilation time,warm ischemia time,cold ischemia time,and indexes of routine laboratory test before donation.Statistical analyses using the Kaplan-Meier method,log-rank test,multivariate step-wise Cox regression were performed.Results Of the 211 donors,univariate analysis showed that the overall 6-month,1-,and 3-year survival rate after DCD LT was 88%,84%,and 82%,respectively.Univariate analysis showed that donor serum sodium level 〈136 mmol/L （P =0.018） and cold ischemia time 〉9 h （P =0.013） were all significant risk factors affecting overall survival after DCD LT.Additionally,donor BMI 〉30 kg/m2 （P =0.011） and donor age 〉60 years （P =0.025） were significantly associated with postoperative complications.Multivariate analysis showed that donor serum sodium level （P=0.025） was an independent risk factor of survival after DCD LT.Conclusion To select suitable DCD liver allografts and control risk factors of donor can help to improve outcomes of recipients.

关 键 词：心死亡供者 肝移植 受者 预后 

分 类 号：R657.3[医药卫生—外科学]