高龄供肝对肝移植术后并发症的影响——148例受者预后分析及思考  

The effect of elderly donor liver on the complications of recipient after liver transplantation——prognosis analysis and reflection of 148 patients

作　　者：杨梦凡 魏绪勇[1] 王琨[1] 鲁迪[1] 陈俊丽 岑贝妮 杨墨丹 郑树森[1,3] 徐骁 Yang Mengfan;Wei Xuyong;Wang kun;Lu Di;Chen Junli;Cen Beini;Yang Modan;Zheng Shusen;Xu Xiao(Department of Hepatobiliary and Pancreatic Surgery,First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,Zhejiang,China;China Liver Transplant Registry,Hangzhou 310003,Zhejiang,China;Department of Hepatobiliary and Pancreatic Surgery,Shulan(Hangzhou)Hospital,Hangzhou 310004,Zhejiang,China)

机构地区：[1]浙江大学医学院附属第一医院肝胆胰外科,浙江杭州310003 [2]国家肝脏移植质控中心,浙江杭州310003 [3]树兰医院肝胆胰外科,浙江杭州310004

出　　处：《实用器官移植电子杂志》2020年第2期101-105,共5页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：国家杰出青年科学基金(81625003);国家自然科学基金项目(81930016,81570589);教育部长江学者奖励计划(T2014146);国家科技重大专项(2017ZX10203205)。

摘　　要：目的研究高龄供肝对肝移植术后移植物功能及受者生存率的影响及其干预策略。方法根据供者年龄≥或<60岁1:1配对选取2016年1月—2017年6月期间行肝移植手术患者为研究对象,分为高龄供者(elderly donor,ED,n=74)组和非高龄供者(non-elderly donor,NED,n=74)组。比较分析受者肝功能恢复情况、并发症、移植物及受者生存率。结果ED组移植物早期功能不全发生率为47.3%,显著高于NED组的28.4%(P=0.018);ED组胆道并发症发生率为21.6%,显著高于NED组的9.5%(P=0.041);ED组移植物存活率显著低于NED组(P=0.023)。ED组冷缺血时间>12 h者移植物早期功能不全发生率显著高于<12 h者(70.6%比40.4%,P=0.003)。结论高龄供肝的使用会影响移植物早期功能恢复及其1年存活率,缩短冷缺血时间可以显著降低EAD的发生率,改善受者预后。Objective To investigate the effect and intervention strategy of adopting elderly donor liver on graft function and survival rate of recipients after liver transplantation.Methods The patients who underwent liver transplantation from January 2016 to June 2017 were paired selected and divided into two groups based on the age of donors≥or<60 years old:the elderly donor(ED,n=74)group and the non-elderly donor(NED,n=74)group.The recovery of liver function,complications,graft and recipient survival rate were compared.Results The incidence of early allograft dysfunction and biliary complications in the ED group were 47.3%and 21.6%,significantly higher than those in the NED group which were 28.4%and 9.5%(P=0.018,P=0.041).The survival rate of grafts was significantly lower in the NED group compared with ED group(P=0.023).In ED group,the incidence of early allograft dysfunction was 70.6%in patients with cold ischemia time>12 h,significantly higher than 40.4%in patients with cold ischemia time<12 h(P=0.003).Conclusion The application of elderly donor liver will influence the early functional recovery and survival rate of the graft.Shortening CIT could significantly reduce the incidence of early allograft dysfunction and improve the prognosis of the recipient.

关 键 词：肝移植 早期移植物功能不全 胆道并发症 移植物存活率 受者生存率 

分 类 号：R657.3[医药卫生—外科学]