公民逝世后器官捐献供肝移植术后早期肝功能不全的危险因素分析  

RISK FACTORS FOR PRIMARY GRAFT DYSFUNCTION AFTER LIVER TRANSPLANTATION FROM DONATION AFTER CARDIAC DEATH

作　　者：王婷婷[1] 姜英俊[2] 解曼[1] 孔心涓[1] 饶伟[3] 臧运金[3] 

机构地区：[1]青岛大学附属医院消化内科,山东青岛266003 [2]青岛大学附属医院急诊外科,山东青岛266003 [3]青岛大学附属医院器官移植中心,山东青岛266003

出　　处：《青岛大学医学院学报》2017年第3期287-290,293,共5页Acta Academiae Medicinae Qingdao Universitatis

基　　金：青岛市自主创新重大专项(14-6-1-6-zdzx)

摘　　要：目的观察公民逝世后器官捐献(DCD)供肝移植术后早期肝功能不全(PGD)的发生情况,并分析PGD发生的危险因素。方法回顾性分析2014年7月—2016年3月于我院器官移植中心行肝移植的42例供受体病人的临床资料,其中供体资料包括性别,年龄,血型,死亡原因,ICU住院时间,脂肪变性的程度,冷缺血时间(CIT),热缺血时间(WIT),术前血丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TB)水平等;受体资料包括性别,年龄,血型,原发病,术前终末期肝病模型(MELD)评分,术中的失血量、输血量、无肝期时间,手术时间,术后ICU住院时间等。对上述因素先进行单因素分析,然后将差异有显著性的因素纳入Logistic回归多因素分析。结果 42例肝移植病人移植术后PGD的发生率为52.4%。PGD组和非PGD组受者术后1、6、12个月的累积生存率分别为95.45%、86.36%、86.36%和95.00%、94.44%、94.44%,组间比较差异无统计学意义(P>0.05)。供体ICU住院时间≥72h(OR=4.612,95%CI=1.283~16.579,P<0.05)和CIT≥8h(OR=6.097,95%CI=1.030~36.070,P<0.05)是PGD发生的独立危险因素。结论供体ICU住院时间≥72h和CIT≥8h是DCD供肝移植病人术后PGD发生的独立危险因素。缩短供体的CIT和ICU住院时间可能有助于降低肝移植术后PGD的发生率。Objective To investigate the incidence of primary graft dysfunction（PGD）after liver transplantation from donation after cardiac death（DCD）and the risk factors for PGD. Methods A retrospective study was performed for the clinical data of 42 donors and recipients who underwent liver transplantation in Center of Organ Transplantation in our hospital from July2014 to March 2016.The donor data included sex,age,blood type,cause of death,length of intensive care unit（ICU）stay,degree of steatosis,cold ischemia time（CIT）,warm ischemia time（WIT）,and preoperative serum levels of alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,and total bilirubin（TB）,and the recipient data included sex,age,blood type,primary disease,preoperative Model for End-Stage Liver Disease（MELD）score,intraoperative blood loss,blood transfusion volume,duration of anhepatic phase,time of operation,and length of postoperative ICU stay.A univariate analysis was performed for these factors,and then a logistic regression analysis was performed for the factors with significant difference. Results The incidence rate of PGD after liver transplantation was 52.4%.The 1-,6-,and 12-month cumulative survival rates were 95.45%,86.36%,and 86.36%in the PGD group and 95.00%,94.44%,and 94.44%in the non-PGD group,and there were no significant differences between the two groups（P〉0.05）.Length of ICU stay≥72h（OR=4.612,95%CI=1.283-16.579,P0.05）and CIT ≥8h（OR =6.097,95%CI=1.030-36.070,P〈0.05）in donors were independent risk factors for PGD. Conclusion Length of ICU stay≥72hand CIT ≥8hin donors are independent risk factors for PGD.Therefore,shortening donor＇s CIT and length of ICU stay may help to reduce the incidence rate of PGD after liver transplantation.

关 键 词：肝移植 公民逝世后器官捐献 肝功能不全 危险因素 

分 类 号：R657.3[医药卫生—外科学] R575[医药卫生—临床医学]