遗体捐献供肝儿童肝移植术后早期移植物功能不全的危险因素分析  

Analysis of risk factors of early allograft dysfunction after deceased donor liver transplantation in children

作　　者：张国锋 高伟[1] Zhang Guofeng;Gao Wei(Department of Children's Organ Transplantation,Tianjin First Central Hospital,Tianjin Key Laboratory of Organ Transplantation,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院肝移植科天津市器官移植重点实验室,天津300192

出　　处：《中华器官移植杂志》2025年第2期141-149,共9页Chinese Journal of Organ Transplantation

基　　金：天津市自然科学基金面上项目(21JCYBJC01130);天津市自然科学基金面上项目(21JCYBJC01600)。

摘　　要：目的:探讨遗体捐献供肝儿童肝移植术后早期移植物功能不全(early allograft dysfunction,EAD)的危险因素。方法:回顾性分析2018年1月1日至2023年12月31日期间在天津市第一中心医院进行遗体捐献供肝儿童肝移植的390例受者及相应供者的临床资料,根据受者术后是否发生EAD分为EAD组(152例)和非EAD(238例)两组,比较两组受者及移植物存活率,运用多因素logistic回归分析筛选独立危险因素,进一步绘制列线图、受试者操作特征曲线(receiver operating characteristic curve,ROC curve)等验证预测效能。结果:390例遗体捐献体供肝儿童肝移植中,152例发生EAD,发生率为38.97%。EAD组术后ICU住院时间、呼吸机支持时间高于非EAD组,差异有统计学意义(均P<0.05)。EAD组和非EAD组相比较,移植物术后1个月、3个月累积存活率分别为90.8%比97.1%、90.7%比95.4%,差异有统计学意义(χ^(2)=4.36,P=0.037);受者1个月、3个月累积存活率分别为93.4%比97.9%、92.8%比96.6%,差异无统计学意义(χ^(2)=3.15,P=0.076)。多因素回归分析显示,EAD的独立危险因素为受者体重(P=0.0091)、术前血乳酸水平(P=0.0065)、供者年龄(P=0.0434)、手术时间(P<0.01)和冷缺血时间(P<0.01)以及关腹前肝门静脉血流量(portal venous flow,PVF)(P=0.0241),并且可联合预测EAD发生[曲线下面积(area under the curve,AUC)=0.75,95%CI:0.70~0.80,P<0.05]。结论:受者体重、术前乳酸水平、供者年龄、手术持续时间、冷缺血时间以及关腹前PVF与遗体捐献供肝儿童肝移植术后EAD发生相关,应完善供受者的术前评估、优化手术流程,以减少EAD并改善预后。Objective:To investigate the risk factors for early allograft dysfunction(EAD)following deceased donor liver transplantation in pediatric recipients.Method:A retrospective analysis was conducted on 390 pediatric liver transplant recipients who underwent deceased donor liver transplantation at Tianjin First Central Hospital between January 1,2018,and December 31,2023.Patients were categorized into the EAD group(152 cases)and the non-EAD group(238 cases)based on the presence or absence of EAD.Patient and graft survival rates were compared between the two groups.Multivariate logistic regression analysis was performed to identify independent risk factors for EAD.A nomogram was constructed and validated using receiver operating characteristic(ROC)curves to assess predictive performance.Result:Among the 390 pediatric liver transplant recipients,152 cases(38.97%)developed EAD.Postoperative intensive care unit(ICU)stay and duration of ventilatory support were significantly longer in the EAD group compared to the non-EAD group(P<0.05).The 1-month(90.8%vs.97.1%)and 3-month(90.7%vs.95.4%)cumulative graft survival rates were significantly lower in the EAD group than in the non-EAD group(χ^(2)=4.36,P=0.037).However,the 1-month(93.4%vs.97.9%)and 3-month(92.8%vs.96.6%)cumulative recipient survival rates showed no statistically significant difference between the two groups(χ^(2)=3.15,P=0.076).Multivariate logistic regression analysis identified recipient weight(P=0.0091),preoperative blood lactate level(P=0.0065),donor age(P=0.0434),operative duration(P<0.01),cold ischemia time(P<0.01),and portal venous flow(PVF)before abdominal closure(P=0.0241)as independent risk factors for EAD.The combination of these factors demonstrated good predictive performance for EAD,with an area under the curve(AUC)of 0.75(95%CI:0.70~0.80,P<0.05).Conclusion:Recipient weight,preoperative blood lactate levels,donor age,operative duration,cold ischemia time,and PVF before abdominal closure are significantly associated with the development of EAD in pe

关 键 词：肝移植 儿童肝移植 早期移植物功能不全 危险因素 预后 

分 类 号：R726.5[医药卫生—儿科]