死亡捐献供肝移植术后真菌感染分布特征及危险因素分析  

Distribution characteristics and risk factors of fungal infection after liver transplantation from deceased donation

作　　者：王东 周顺 王勇[1] 李长贤 李相成 Wang Dong;Zhou Shun;Wang Yong;Li Changxian;Li Xiangcheng(Hepatobiliary Center,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院肝胆中心,南京210029

出　　处：《中华器官移植杂志》2022年第11期670-674,共5页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金(81670570)。

摘　　要：目的探讨死亡捐献(deceased donation,DD)供肝移植术后真菌感染的病原菌特点及其相关危险因素,为制定更合理的感染控制策略提供依据。方法收集南京医科大学第一附属医院2019年2月至2020年9月接受死亡捐献供肝移植手术的187例受者临床资料,采集术后真菌感染相关数据,并通过单因素分析和多元Logistic回归分析确定独立危险因素。结果187例DD供肝移植受者发生术后真菌感染26例,病死率为46.2%(12/26)。其中,肺部感染最多见,占80.8%(21/26);白色念珠菌是最常见菌株,占53.3%(16/30)。手术时间≥8 h(OR=3.610,95%CI:1.079~12.081,P=0.037)、二次手术(OR=39.234,95%CI:3.512~438.258,P=0.003)、ICU住院时间≥7 d(OR=10.070,95%CI:3.480~29.140,P=0.002)是发生术后真菌感染的独立危险因素。结论术后真菌感染严重威胁DD供肝移植受者的预后,在保证手术质量的基础上尽量缩短手术时间、严格把握二次手术指征、术后早期转出ICU病房对于降低DD供肝移植术后真菌感染风险尤为重要。Objective To explore the pathogenic characteristics and related risk factors of fungal infection after liver transplantation(LT)from deceased donation and provide rationales for formulating optimal control strategies.Methods From February 2019 to September 2020,clinical data were retrospectively reviewed for 187 recipients after LT from deceased donation.Univariate and multiple Logistic regression analyses were performed for determining the independent risk factors of postoperative fungal infection.Results Among 187 LT cases,26 cases had postoperative fungal infection with a mortality rate of 46.2%(12/26).Lung was the most common fungal infection site,accounting for 80.8%(21/26).The most common pathogenic bacteria of fungal infection were Candida albicans,accounting for 53.3%(16/30).Multiple Logistic regression analysis indicated that operative duration≥8 h(OR=3.610,95%CI:1.079-12.081,P=0.037),re-operation(OR=39.234,95%CI:3.512-438.258,P=0.003)and intensive care unit(ICU)retention time≥7 d(OR=10.070,95%CI:3.480-29.140,P=0.002)were independent risk factors of postoperative fungal infection.Conclusions Postoperative fungal infection is a serious threat to the prognosis of recipients of LT from deceased donation.Minimizing operative duration on the basis of ensuring quality of surgery,strictly grasping the indications for re-operation and transferring out of ICU in early postoperative period may help to lower the risks of fungal infection after LT from deceased donation.

关 键 词：肝移植 死亡捐献 真菌 危险因素 

分 类 号：R657.3[医药卫生—外科学]