供肝主要指标与肝移植术后早期预后的相关性研究  

Correlation between the main indicators of organ donation and donor liver and the early prognosis of transplant after the death of citizens

作　　者：丁明杰 温培豪[1] 张嘉凯[1] 王智慧[1] 史晓奕[1] 曹胜利[1] 史冀华[1] 张水军[1] 郭文治[1] Ding Mingjie;Wen Peihao;Zhang Jiakai;Wang Zhihui;Shi Xiaoyi;Cao Shengli;Shi Jihua;Zhang Shuijun;Guo Wenzhi(Department of Hepatobiliary and Pancreatic Surgery,Key Laboratory of Hepatobiliary and Pancreatic Surgery & Digestive Organ Transplantation of Henan Province,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肝胆胰外科,河南省高等学校肝胆胰外科与消化器官移植重点学科开放实验室,450052

出　　处：《中华器官移植杂志》2018年第11期651-655,共5页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金面上项目(81671958,81571947);国家自然科学基金联合基金项目(U1504804).

摘　　要：目的探讨供肝主要指标与肝移植术后早期预后的相关性研究。方法回顾性分析2017年6月至2018年6月166例死亡后器官捐献(DD)供者和受者的临床资料。分析供者年龄、性别、体重指数、血清钠水平、胆红素总量、凝血酶原时间、国际标准化比值等指标对肝移植受者术后早期移植肝功能不全(EAD)的影响。根据供肝保存液培养结果分为阳性组和阴性组,结合肝移植受者术后血、痰、引流液等培养结果,观察两组受者术后早期的感染率。结果单因素分析结果显示,术前供者胆红素总量>17.1mmol/L、供肝冷缺血时间>8h是移植受者术后发生EAD的危险因素。多因素分析结果显示,供肝冷缺血时间>8h是肝移植受者术后发生EAD的独立危险因素;冷缺血时间>8h组受者EAD发生率显著高于冷缺血时间≤8h组受者(26.3%与7.0%),差异有统计学意义(P=0.003)。供肝保存液培养阳性组受者术后痰培养和引流液培养阳性率分别为43.9%和48.8%,显著高于阴性组受者的10.7%和13.1%,差异均有统计学意义(P=0.000,P=0.000);阳性组和阴性组受者术后血培养阳性率分为12.2%和6.0%,差异无统计学意义(P=0.161)。结论供肝冷缺血时间>8h是肝移植受者术后发生EAD的独立危险因素,缩短供肝冷缺血时间可降低受者术后EAD的发生率;保存液培养结果对受者术后抗感染治疗具有一定的指导作用。Objective To explore the correlation between main indicators of donor liver and early prognosis after liver transplantation.Methods The clinical data of 166 donors and recipients of post-mortem organ donation (DD) from June 2017 to June 2018 were retrospectively analyzed.The effects of donor age,sex,body mass index,serum sodium level,total bilirubin,prothrombin time and international standardized ratio on early allograft dysfunction (EAD) in liver transplant recipients were investigated.According to the culture results of donor liver preservation solution,the results were divided into positive group and negative group.Combined with the culture results of blood,sputum and drainage fluid after liver transplantation,the early infection rate of recipients in the two groups was observed.Results Univariate analysis showed that preoperative donor bilirubin total >17.1 mmol/L and donor cold ischemia time >8 h were risk factors for postoperative EAD in transplant recipients.Multivariate analysis showed that donor cold ischemia time >8 h was an independent risk factor for postoperative EAD in liver transplant recipients;the incidence of EAD in the group with cold ischemia time >8 h was significantly higher than that in the group with cold ischemia time ≤8 h (26.3% vs.7.0%;P=0.003).The positive rate of postoperative sputum culture and drainage fluid culture in the donors with positive donor culture was 43.9% and 48.8%,respectively,which was significantly higher than that in the negative group (10.7% and 13.1%).The difference was statistically significant (P=0.000,P=0.000).The positive rate of postoperative blood culture in the positive group and the negative group was 12.2% and 6.0% with the difference being not statistically significant (P=0.161).Conclusion Cold ischemia time of the donor >8 h is an independent risk factor for EAD in recipients after liver transplantation.Shortening the cold ischemia time of donor liver can reduce the incidence of postoperative EAD in recipients.The culture results of preservation soluti

关 键 词：肝移植 评估 早期肝功能不全 冷缺血时间 

分 类 号：R657.3[医药卫生—外科学]