DCD供体质量对肝移植术后感染的危险因素分析  

Risk factors of DCD donor quality for infection after liver transplantation

作　　者：邵文雨[1] 黄新立[1] 周浩明 仲伟哲 王平[1] 

机构地区：[1]南京医科大学第一附属医院肝胆外科,南京210029

出　　处：《肝胆外科杂志》2018年第4期259-262,共4页Journal of Hepatobiliary Surgery

摘　　要：目的研究心脏死亡后器官捐献(DCD)供体质量对肝移植术后感染的危险因素。方法选取我院2015年1月至2017年1月128例DCD肝移植受者为研究对象,统计肝移植术受者住院期间感染发生率,根据有无术后感染将受者分组。对所有受者进行为期1年随访,比较感染组与未感染组术后1年生存情况。收集DCD供体年龄、性别、体重指数、有无脂肪肝、热缺血时间、冷缺血时间、血钠、血钾、白蛋白、总胆红素、谷丙转氨酶、谷草转氨酶。结果 128例肝移植受者在住院期间,共63例发生术后感染,感染率为49. 2%。共分离151株病原菌,革兰阳性菌65株,占43. 0%;革兰阴性菌71株,占47. 0%;真菌15株,占9. 9%。术后1年随访中,感染组累积生存率显著低于未感染组(P <0. 05)。感染组体重指数≥24kg/m^2、中或重度脂肪肝供体比例显著高于未感染组(P <0. 05),白蛋白显著低于未感染组(P <0. 05),冷缺血时间、总胆红素显著高于未感染组(P <0. 05)。经Logistic回归分析显示,供体脂肪肝、冷缺血时间、总胆红素是肝移植术后感染的独立危险因素,白蛋白是其独立保护因素。结论供体体重指数、脂肪肝、冷缺血时间、白蛋白、总胆红素等DCD供体质量因素对肝移植术后感染有显著影响。Objective To study the risk factors of donors quality of Donation after Cardiac Death （DCD） for infection after liver transplantation. Methods 128 cases of receptors with DCD liver transplantation from January 2015 to January 2017 in our hospital were selected for the study. The incidence rate of infection during hospitalization was counted, and the receptors were grouped according to whether there was postoperative infection or not. All receptors were given 1-year follow-up, and the survival at 1 year after operation was compared between infection group and non-infection group. DCD donors were collected for age, gender, body mass index, presence or absence of fatty liver, warm ischemia time, cold ischemia time, serum sodium, serum potassium, albumin, total bilirubin, alanine aminotransferase and aspartate aminotransferase. Results Among 128 cases of liver transplant recipients, there were 63 cases of postoperative infections with the infection rate of 49.2% during hospitalization. 151 strains of pathogenic bacteria were iso- lated, including 65 strains of Gram-positive bacteria for 43.0%, 71 strains of Gram-negative bacteria for 47.0% and 15 strains of fungi for 9.9%. During 1-year follow-up after operation, the cumulative survival rate in infection group was significantly lower than that in non-infection group （P 〈0. 05）. The proportions of body mass index≥24 kg/m^2, and donors with moderate or severe fatty liver in infection group were significantly higher than those in non-infection group （ P 〈 0. 05 ） , and the albumin level was significantly lower than that in non-infection group （ P 〈 0. 05 ） while the cold iscbemia time and total bilirubin were significantly higher than those in non-infection group （ P 〈 0. 05 ）. Logistic regression analysis showed that donor fatty liver, cold ischemia time and total bilirubin were independent risk factors for infection after liver transplantation, and albumin was an independent protective factor. Conclusions Donor body mass index, fatty live

关 键 词：肝移植 心脏死亡后器官捐献 供体质量 感染 

分 类 号：R575[医药卫生—消化系统]