中重度脂肪变性供肝应用于成人肝移植术的早期预后及其危险因素分析  

Analysis of early prognosis and risk factors of donor liver with moderate-to-severe steatosis in adult liver transplantation

作　　者：田大治 蒋文涛[1,2] 陈池义 于杨[1] 仇佳丽 Tian Dazhi;Jiang Wentao;Chen Chiyi;Yu Yang;Qiu Jiali(The First Central College of Tianjin Medical University,Tianjin 300110,China;不详)

机构地区：[1]天津医科大学一中心临床学院,300110 [2]天津市第一中心医院肝移植科

出　　处：《器官移植》2020年第6期698-703,736,共7页Organ Transplantation

基　　金：国家自然科学基金面上项目(81870444);天津市科技计划项目慢性病防治科技重大专项(17ZXMFSY00040);天津市第一中心医院科技基金(TFCHCF201812)。

摘　　要：目的探讨中重度脂肪变性供肝肝移植受者的早期预后及其发生移植物功能延迟恢复(DGF)的危险因素。方法回顾性分析公民逝世后器官捐献供肝肝移植供、受者各475例的临床资料,根据澳大利亚国家肝移植中心(ANLTU)脂肪变性供肝分级,将接受相应供肝的受者分为S0组(无脂肪变性,308例)、S1组(轻度脂肪变性,97例)、S2组(中度脂肪变性,52例)、S3组(重度脂肪变性,18例)4组。比较各组受者术后早期死亡及并发症发生情况,对可能导致受者发生DGF的供者因素、受者因素、手术因素进行单因素及多因素logistic回归分析。结果S2组及S3组术后DGF的发生率高于S1组及S0组(均为P<0.05),S3组术后DGF发生率高于S2组(P<0.05);各组受者的术后早期病死率,移植肝原发性无功能(PNF)、术后出血、感染、胆道并发症和血管并发症的发生率等指标,差异均无统计学意义(均为P>0.05)。单因素分析结果提示,供者供肝脂肪变性程度较严重、冷缺血时间长和受者术前终末期肝病模型(MELD)评分高、存在肿瘤是发生DGF的危险因素,差异均有统计学意义(均为P<0.05)。多因素logistic回归分析结果提示,供者供肝中重度脂肪变性、冷缺血时间>8 h及受者MELD评分>30分是术后早期发生DGF的独立危险因素。结论中重度脂肪变性供肝应用于成人肝移植术后早期易发生DGF,但不影响受者术后早期生存率。对于中重度脂肪变性供肝的选用应结合供者冷缺血时间及受者术前MELD评分等因素综合考虑。Objective To explore the early prognosis and the risk factors of delayed graft function(DGF)of the recipients undergoing liver transplantation from donor liver with moderate-to-severe steatosis.Methods Clinical data of 475 donors and 475 recipients undergoing liver transplantation from donor liver of organ donation after citizen's death were retrospectively analyzed.According to the classification criteria of steatosis proposed by Australia National Liver Transplantation Unit(ANLTU),all recipients were divided into the S0 group(no steatosis,n=308),S1 group(mild steatosis,n=97),S2 group(moderate steatosis,n=52)and S3 group(severe steatosis,n=18),respectively.The early postoperative death and incidence of postoperative complications were statistically compared among each group.The risk factors from donors,recipients and operation leading to DGF were analyzed by univariate and multivariate logistic regression models.Results The incidence of postoperative DGF in the S2 and S3 groups was significantly higher than that in the S1 and S0 groups(all P<0.05).The incidence of postoperative DGF in the S3 group was remarkably higher than that in the S2 group(P<0.05).The early postoperative fatality,the incidence of primary nonfunction(PNF)of the transplant liver,postoperative bleeding,infection,biliary complications and vascular complications did not significantly differ among each group(all P>0.05).Univariate regression analysis showed that severe steatosis of donor liver,long cold ischemia time,high model for end-stage liver disease(MELD)score and tumors of the recipients before operation were the risk factors of DGF(all P<0.05).Multivariate logistic regression analysis demonstrated that moderate-to-severe steatosis of donor liver,cold ischemia time>8 h and MELD score>30 of the recipients were the independent risk factors for early postoperative DGF.Conclusions The early-stage incidence of DGF after adult liver transplantation from donor liver with moderate-to-severe steatosis is high,whereas it does not affect the early su

关 键 词：肝移植 脂肪变性供肝 终末期肝病模型(MELD) 移植物功能延迟恢复 冷缺血 原发性无功能 公民逝世后器官捐献 

分 类 号：R617[医药卫生—外科学]