公民身后器官捐献肝脏质量标准供者评分系统研究  

Liver quality standards and donor scoring system for citizen organ donation after death

作　　者：何睿[1] 黄颖滨 韩明[1] 王小平[1] 周健[1] 袁小鹏[1] 郑毅涛[1] 陈岗[1] 廖苑[1] 李劲东 朱晓峰[1] 邰强[1] 黄洁夫[1] 焦兴元[1] He Rui;Huang Yingbin;Han Ming;Wang Xiaoping;Zhou Jian;Yuan Xiaopeng;Zheng Yitao;Chen Gang;Liao Yuan;Li Jingdong;Zhu Xiaofeng;Tai Qiang;Huang Jiefu;Jiao Xingyuan(Organ Transplantation Center,the First Affiliated Hospital,Sun Yat-Sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院器官移植中心,广州510080

出　　处：《中华普通外科杂志》2022年第11期801-806,共6页Chinese Journal of General Surgery

基　　金：国家自然科学基金(81270531);广东省科技计划项目(K0215014);广州市科技计划项目(K0220048)。

摘　　要：目的分析公民身后器官捐献供肝移植后发生移植肝失功能的危险因素。方法回顾性分析2011年11月至2018年12月中山大学附属第一医院器官捐献和移植中心供者资料和肝移植受体资料。应用倾向性评分匹配法对供者和肝移植受者资料进行评估和筛选,得到供受体间协变量均衡的样本。结果供者男70例,女20例,年龄(40.6±16.3)岁,受者男70例,女20例,年龄(41.8±20.3)岁。移植肝失功能与下列参数显著相关:供者心肺复苏时间(t=0.429,P=0.000)、吲哚菁绿15 min滞留率(χ^(2)=67.151,P=0.000)、肝功能分级(χ^(2)=54.154,P=0.000)、大泡性脂肪肝分级(χ^(2)=8.120,P=0.017)、小泡性脂肪肝分级(χ^(2)=16.000,P=0.001)、ICU住院时间(χ^(2)=14.900,P=0.001)、血肌酐水平(χ^(2)=44.685,P=0.000)。本研究建立了公民身后器官捐献肝脏质量标准供者评分系统。供肝质量分为四级,很好地对应肝移植受者的预后。结论根据移植肝失功能高危因素分析建立的供者评分系统及分级标准,可以对我国公民身后供肝质量做出客观评价。Objective To establish donor liver quality related risk factors for the loss of function of transplanted liver.Methods The data of donors and recipients of liver transplantation at the Organ Donation and Transplantation Center of the First Affiliated Hospital of Sun Yat-sen University from Nov 2011 to Dec 2018 were analyzed retrospectively.Propensity score matching(PSM)was performed to evaluate and screen the data of donors and recipients,in order to balance the covariates.Results Of the organ donation,there were 70 males and 20 females,aging(40.6±16.3)years.Of the liver transplantation recipients,there were 70 males and 20 females,aging(41.8±20.3)years.Liver dysfunction after transplantation was significantly correlated with the following variables:the donor's CPR time(t=0.429,P=0.000),15-minute retention rate of indocyanine green(χ^(2)=67.151,P=0.000),liver function grading(χ^(2)=54.154,P=0.000),bullae fatty liver grading(χ^(2)=8.120,P=0.017),vesicular fatty liver grading(χ^(2)=16.000,P=0.001),ICU stay time(χ^(2)=14.900,P=0.001)and serum creatinine level(χ^(2)=44.685,P=0.000).The donor scoring system was established in our studying.For the 90 organ donation cases,the donated liver quality were classified into four levels,which were of good correspondence to the prognosis of the recipients.Conclusion This donor scoring system and grading standards established by analyzing the high-risk factors of liver dysfunction after transplantation helps evaluate the quality of donor liver in China.

关 键 词：肝移植 原发性移植物功能障碍 供者评分 供肝评分 倾向性评分匹配 

分 类 号：R657.3[医药卫生—外科学]