Correlation analysis between the status of DBCD donors and postoperative recovery of organ function in organ transplant recipients
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摘要:
目的 探讨脑-心双死亡器官捐献(DBCD)供体状态与其肝、肾移植受者术后器官功能恢复的相关性。 方法 回顾性分析2011年8月至2013年11月四川省人民医院器官移植中心的12例DBCD供体评估资料及器官保护措施, 以及由其提供器官的12例肝移植、22例肾移植受者术后恢复的各项指标。将供体各项指标分别与其肝移植、肾移植受者术后恢复指标进行相关性分析。 结果 肝移植受者术后发生肝脏原发无功能(PNF)1例(1/12, 8%), 肾移植受者术后发生移植物功能延迟恢复(DGF)11例(11/22, 50%)。经统计学分析, 供体入住重症监护室(ICU)时间、肝功能、维持收缩压、凝血功能、血糖、电解质(血Na+、K+)等指标, 与其肝、肾移植受者术后器官功能恢复的相关性均有统计学意义(均为P < 0.05)。年龄、脑死亡原因、维持舒张压、活化部分凝血活酶时间(APTT)、动脉血pH值与其相应肝移植受者术后恢复存在相关性。总胆红素、白细胞计数与其相应肾移植受者术后恢复存在相关性。 结论 DBCD供体是适合我国国情的器官移植供体。DBCD肝移植受者术后PNF发生率较低, 肾移植受者术后DGF发生率较高。根据影响因素有针对性地进行供体评估和器官保护工作, 有助于提高DBCD的肝、肾移植效果。 Abstract:Objective To analyze the correlation between the status of the donation after brain and cardiac death (DBCD) donors and postoperative recovery of the organ function in the liver and renal transplant recipients. Methods The assessment data and organ protection measures of 12 DBCD donors admitted to the Organ Transplantation Center in Sichuan Provincial People's Hospital from August 2011 to November 2013 were retrospectively analyzed. The parameters of postoperative recovery of 12 liver and 22 renal transplant recipients were also assessed. The correlation between the parameters of the donors and postoperative recovery of the liver and renal transplant recipients was statistically analyzed. Results Among 12 liver transplant recipients, 1 patient had primary non-function (PNF) (1/12, 8%) and 11 cases developed delayed graft function (DGF) after renal transplantation (11/22, 50%). Intensive care unit (ICU) period, liver function, maintaining systolic blood pressure (SBP), blood coagulation function, blood glucose level and electrolyte (Na+/K+) were significantly correlated with postoperative recovery of the liver and kidney function in the recipients (all in P < 0.05). Age, cause of brain death, maintaining diastolic blood pressure (DBP), activated partial thromboplastin time (APTT) and pH of arterial blood gas (ABG) were associated with postoperative recovery of the liver function. Total bilirubin and white blood cell count (WBC) were correlated with postoperative recovery of kidney function. Conclusions DBCD donors cater to the specific conditions in China. The incidence of postoperative PNF in liver recipients is relatively low whereas and the incidence of DGF after renal transplantation is relatively high. Assessment of the DBCD donors and organ protection measures should be specifically taken to enhance the clinical efficacy of liver and renal transplantation from DBCD donors. -
Key words:
- Organ transplantation /
- Liver transplantation /
- Renal transplantation /
- Donor
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表 1 肝移植供体评估项目与受者术后情况相关分析结果
Table 1. The result of the correlation between the assessment of the liver transplant donors and the postoperative situation of the recipients
供体评估项目 受者术后情况 t值 P值 年龄 术后14 d INR -3.684 0.011 术后7 d总胆红素 -2.949 0.042 术后14 d总胆红素 4.352 0.017 脑死亡原因 术后7 d总胆红素 3.261 0.022 入住ICU时间 术后入住ICU时间 2.679 0.037 术后21 d INR -5.719 0.004 术后红细胞悬液用量 -10.190 0.001 术后14 d INR 7.186 0.006 AST 术后14 d总胆红素 5.229 0.002 术后21 d INR -2.976 0.031 术后7 d ALT -3.715 0.021 术后7 d总胆红素 4.993 0.015 ALT 术后14 d ALT 3.796 0.009 维持收缩压 术后7 d INR -3.270 0.017 术后红细胞悬液用量 -3.196 0.024 术后呼吸机使用时间 3.479 0.025 术后14 d总胆红素 -3.537 0.038 维持舒张压 术后白蛋白用量 -2.460 0.049 PT 术后14 d ALT 4.174 0.006 术后呼吸机使用时间 4.294 0.008 APTT 术后14 d ALT 7.969 0.001 术后14 d总胆红素 5.372 0.003 INR 术后14 d ALT 4.483 0.004 动脉血pH值 术后21 d ALT 3.597 0.011 术后入住ICU时间 3.510 0.017 术后21 d INR -2.899 0.028 血糖 术后14 d ALT -2.696 0.043 术后14 d INR 3.510 0.045 血K+ 术后7 d INR -3.452 0.014 术后血浆用量 3.573 0.016 术后白蛋白用量 4.820 0.009 术后21 d INR 4.617 0.019 术后7 d ALT -4.378 0.048 血Na+ 术后7 d ALT 2.746 0.033 
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表 2 肾移植供体评估项目与受者术后情况相关分析结果
Table 2. The result of the correlation between the assessment of the renal transplant donors and the postoperative situation of the recipients
供体评估项目 受者术后情况 t值 P值 入住ICU时间 出院时Scr 2.643 0.016 AST 术后发生DGF -2.600 0.017 ALT 术后透析次数 3.253 0.004 术后14 d Scr -3.473 0.003 总胆红素 出院时Scr -3.072 0.006 肺部感染 2.149 0.045 维持收缩压 术后3 d Scr -2.745 0.012 白细胞计数 住院时间 2.870 0.009 出院时Scr -2.270 0.001 血红蛋白 术后3 d Scr 3.985 0.005 PT 出院时Scr -4.425 0.043 INR 出院时Scr -3.973 0.001 血糖 术后透析次数 2.216 0.038 住院时间 -2.985 0.008 血K+ 术后14 d Scr -2.279 0.034 血Na+ 发生AR -2.383 0.027 术后14 d Scr 2.106 0.049 DGF为移植物功能延迟恢复
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