公民器官捐献供体质量对肝移植术后受体生存率的影响  

The influence of the quality of organ donation on the outcome of liver transplantation and the survival rate of recipients

作　　者：张莉莉[1] 于涛 田彦 冯丽彦 周彪 杨晓静 白兰 Zhang Lili;Yu Tao;Tian Yan;Feng Liyan;Zhou Biao;Yang Xiaojing;Bai Lan(Department of Organ Transplantation Management,the Third Medical Center,Chinese PLA General Hospital,Beijing 100039,China;Medical Department of Peking University People's Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第三医学中心器官移植管理科,北京100039 [2]北京大学人民医院医务处,北京100039

出　　处：《实用器官移植电子杂志》2024年第2期104-108,共5页Practical Journal of Organ Transplantation(Electronic Version)

摘　　要：目的探讨心脏死亡器官捐献(donation after cardiac death,DCD)供体质量对肝移植术后受体生存率的影响。方法回顾性分析2018年1月至2021年1月解放军总医院第三医学中心DCD肝移植手术患者100例,移植术后进行为期1年的随访调查,观察肝移植受者的生存状态,对相关危险因素加以分析。结果100例肝移植受者术后1年病死率为3%(3/100),其死亡因素与供体冷缺血时间、供体脂肪肝、术中出血量、供体白蛋白及总胆红素水平、肝细胞水肿密切相关(P<0.05)。多因素Logistic回归分析发现,供体冷缺血时间≥840 min、脂肪肝是影响肝移植受者生存状态的独立危险因素(P<0.05)。肝移植术后感染率为26%(26/100),其肝移植术后感染率与受体肝功能Child-Pugh评分、术前血红蛋白水平、血小板计数、术中输血量、术后重症监护病房(intensive care unit,ICU)留观时间密切相关(P<0.05)。结论DCD供体质量对肝移植术后受体生存率具有显著影响,供体冷缺血时间、供体脂肪肝对肝移植术后受体生存状态具有重要影响。Objective To investigate the effect of donor quality on the survival rate of liver transplantation recipients after cardiac death organ donation(DCD).Methods A retrospective analysis was performed on 100 patients who received DCD liver transplantation from January 2018 to January 2021.A 1-year follow-up survey was conducted after transplantation to observe the survival status of liver transplantation recipients and to analyze the risk factors affecting liver transplantation recipients.Results The mortality rate of liver transplantation recipients was 3%(3/100).The mortality factors were closely related to the donor cold ischemia time,donor fatty liver,intraoperative blood loss,donor albumin and total bilirubin levels,and hepatocyte edema(P<0.05).Multivariate Logistic regression analysis showed that donor cold ischemia time≥840 min and fatty liver were independent risk factors for survival status of liver transplantation recipients(P<0.05).The postoperative infection rate of liver transplantation was 26%(26/100),and the postoperative infection rate was closely correlated with child-Pugh score of recipient,preoperative hemoglobin level,platelet count,intraoperative blood transfusion volume and postoperative intensive care unit(ICU)observation time(P<0.05).Conclusion DCD donor quality has a significant impact on the survival rate of recipients after liver transplantation,and the donor cold ischemia time and fatty liver have an important impact on the survival status of recipients after liver transplantation,while the preoperative anemia level,intraoperative blood loss and postoperative ICU observation time of recipients are closely related to the incidence of postoperative infection.

关 键 词：心脏死亡器官捐献供肝 供体质量 肝移植 受体生存率 术后感染 

分 类 号：R657.3[医药卫生—外科学]