Short-term clinical efficacy of liver transplantation with organs from donation after Chinese citizens' death in patients with high model for end-stage liver disease score
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摘要:
目的 探讨高终末期肝病模型(MELD)评分终末期肝病患者接受中国公民逝世后器官捐献供肝肝移植的近期疗效和安全性。 方法 回顾性分析2011年9月至2014年6月在佛山市第一人民医院实施公民逝世后器官捐献供肝肝移植并存活的34例受者的临床资料。根据术前MELD评分, 将受者分为高MELD组(MELD评分≥25分, 8例)和低MELD组(MELD评分 < 25分, 26例)。比较两组受者肝移植术前、术中和术后情况。 结果 术前, 高MELD组需要人工肝治疗者比例、急性肝衰竭和慢加急性肝衰竭的发生率均高于低MELD组(均为P < 0.05)。术中, 两组受者的出血量、输血量、供肝热缺血时间、供肝冷缺血时间、无肝期、手术时间、手术方式等比较, 差异均无统计学意义(均为P > 0.05)。术后, 高MELD组的入住ICU时间长于低MELD组(P < 0.05)。两组术后住院时间、住院病死率、早期并发症发生率、随访时间、总体生存率方面比较, 差异无统计学意义(均为P > 0.05)。肝移植术后高MELD组的天冬氨酸转氨酶(AST)峰值高于低MELD组。两组受者术后胆漏、腹腔脓肿和肝功能不全的发生率比较, 差异有统计学意义(均为P < 0.05)。 结论 高MELD评分终末期肝病患者接受中国公民逝世后器官捐献供肝肝移植能取得较好的近期效果且安全可行。 Abstract:Objective To explore the short-term clinical efficacy and safety after liver transplantation with organs from Chinese donation after citizens' death in patients with high model for end-stage liver disease (MELD) score. Methods The clinical data of 34 liver transplantation recipients with organs from donation after citizens' death from November 2011 to June 2014 in the First People's Hospital of Foshan were retrospectively analyzed. All recipients were divided into the high MELD score (MELD score≥25, n=8) and low MELD score groups (MELD score < 25, n=26) according to preoperative MELD score. Preoperative, intraoperative and postoperative status of the patients was statistically compared between two groups. Results Prior to operation, the proportion of patients requiring artificial liver support and the incidence of acute or chronic and acute liver failure in the high MELD score group were significantly higher than those in the low MELD score group (all in P < 0.05). Intraoperatively, there was no significant difference in blood loss, perfusion volume, warm and cold ischemia time, anhepatic period, operative time and approach between two groups (all in P > 0.05). After operation, the length of intensive care unit (ICU) stay in the high MELD score group was significantly longer than that in the low MELD score group (P < 0.05). And there was no significant difference in the length of hospital stay, mortality during hospitalization, incidence of early complications, follow-up time and overall survival rate between two groups (all in P > 0.05). The peak level of aspartate aminotransferase (AST) in the high MELD score group was significantly higher compared with that in the low MELD score group (P < 0.05). The incidence of bile leakage, abdominal abscess and liver dysfunction significantly differed between two groups (all in P < 0.05). Conclusions It is a safe and short-term efficacious approach to perform liver transplantation with organs obtained from Chinese donation after citizens' death in patients with high MELD score liver recipients. -
表 1 两组肝移植受者的术前情况比较
Table 1. Comparison of preoperative situation of the liver transplant recipients between two groups
项 目 高MELD组(n=8) 低MELD组(n=26) P值 年龄[岁, M(Q)] 45(39～54) 49(38～64) 0.12 性别[男/女, n/n] 8/0 24/2 1.00 乙肝(+)[n(%)] 6(6/8) 24(92) 0.23 丙肝(+)[n(%)] 0 1(4) 1.00 乙肝合并丙肝[n(%)] 0 1(4) 1.00 术前入住ICU时间[n(%)] 1(1/8) 0 0.24 术前机械通气[n(%)] 1(1/8) 1(4) 0.42 术前人工肝[n(%)] 6(6/8) 4(15) 0.00 诊断 乙肝肝硬化[n(%)] 7(7/8) 23(89) 1.00 急性肝衰竭[n(%)] 4(4/8) 3(12) 0.04 慢加急性肝衰竭[n(%)] 4(4/8) 2(8) 0.02 肝癌[n(%)] 1(1/8) 10(39) 0.23 符合米兰标准 0 7(27) 0.36 超出米兰标准 1(1/8) 3(12) 酒精性肝硬化[n(%)] 1(1/8) 0 0.04 自身免疫性肝炎[n(%)] 0 1(4) 0.32 多囊肝、多囊肾[n(%)] 0 1(4) 0.32 MELD评分[M(Q)] 34(26～40) 14(6～23) < 0.0001 等待肝移植时间[d, M(Q)] 11(1～49) 33(1～188) 0.77 供者性别[男/女, n/n] 8/0 23/3 1.00 供者年龄[岁, M(Q)] 27(17～45) 39(15～59) 0.15 供者BMI[kg/m2, M(Q)] 22.5(19.5～24.8) 22(18.3～24.2) 0.53 注：丙肝指丙型病毒性肝炎 
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表 2 两组肝移植受者的术中情况比较
Table 2. Comparison of intraoperative situation of the liver transplant recipients between two groups
项 目 高MELD组(n=8) 低MELD组(n=26) P值 术中出血量[ml, M(Q)] 8 075(1 000～15 000) 6 042(2 300～24 000) 0.31 术中输血量(红细胞)[U, M(Q)] 24(6～48) 17(4～36) 0.31 供肝热缺血时间[min, M(Q)] 5(0～21) 6(0～19) 0.53 供肝冷缺血时间[min, M(Q)] 310(210～510) 318(210～600) 0.51 手术时间[min, M(Q)] 496(420～660) 489(314～720) 0.73 无肝期[min, M(Q)] 76(46～108) 70(41～135) 0.57 肝肾联合移植[n(%)] 1(1/8) 1(4) 0.42
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表 3 两组肝移植受者的术后情况比较
Table 3. Comparison of postoperative situation of the liver transplant recipients between two groups
项 目 高MELD组(n=8) 低MELD组(n=26) P值 入住ICU时间[d, M(Q)] 5(2～8) 4(1～17) 0.04 术后住院时间[d, M(Q)] 26(13～54) 25(11～67) 0.75 住院病死率[n(%)] 0 0 － 早期并发症发生率[n(%)] 6(6/8) 22(85) 0.61 随访时间[月, M(Q)] 8(2～21) 16(2～32) 0.21 受者总体生存率(%) 1个月 100 100 1.00 3个月 100 100 1.00
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表 4 两组肝移植受者术后早期并发症发生情况比较
Table 4. Comparison of early postoperative complications of the liver transplant recipients between two groups
项 目 高MELD组(n=8) 低MELD组(n=26) P值 肺部感染[n(%)] 4(4/8) 7(27) 0.39 胆道吻合口狭窄[n(%)] 3(3/8) 4(15) 0.32 胆漏[n(%)] 0 1(4) 0.04 伤口感染[n(%)] 0 2(8) 1.00 急性排斥反应[n(%)] 2(2/8) 1(4) 0.13 胸腔积液[n(%)] 5(5/8) 20(77) 0.65 腹腔脓肿[n(%)] 0 1(4) 0.04 早期肝功能不全[n(%)] 1(1/8) 0 0.04
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