Analysis of risk factors of initial poor graft function after living donor liver transplantation
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摘要:
目的 分析活体肝移植受体发生早期移植物功能不良(IPGF)的危险因素。 方法 回顾性分析309例活体肝移植病例资料。备选危险因素：(1)供体因素，包括年龄、性别、体质量指数(BMI)；(2)受体因素，包括年龄、性别、BMI，术前肝功能Child-Pugh分级、终末期肝病模型(MELD)评分、术前肾功能不全、血清总胆红素升高、低钠血症、低钾血症；(3)移植物因素，包括移植物冷缺血时间、移植物与受体体质量比(GRWR)；(4)受体手术因素：总手术时间、失血量、输血量、输血小板和无肝期≥100 min。对以上因素进行单因素分析，找出IPGF的潜在危险因素，并进行Logistic回归分析以找出独立危险因素。 结果 与 结论 受体术前肝功能Child-Pugh C级、MELD评分≥20分、血清总胆红素升高(＞68.4 μmol/L)、低钠血症(＜135 mmol/L)、低钾血症(＜3.5 mmol/L)和无肝期≥ 100 min是IPGF的潜在危因素(均为P＜0.05)，其中受体术前肝功能Child-Pugh C级为活体肝移植发生IPGF的独立危险因素(P=0.019)。 Abstract:Objective To identify the risk factors of the incidence rate of initial poor graft function (IPGF) in recipients after living donor liver transplantation. Methods Clinical data of 309 patients undergoing living donor liver transplantation were retrospectively analyzed. Candidate risk factors: (1) donor factors included age, gender and body mass index (BMI); (2) recipient factors included age, gender, BMI and preoperative Child-Pugh classification, model for end-stage liver disease (MELD) grading, preoperative renal insufficiency, serum total bilirubin elevation, hyponatremia and hypopotassaemia; (3) graft factors included graft cold ischemia time, graft recipient weight ratio (GRWR); (4) recipient surgery factors included total operation time, blood loss volume, blood transfusion volume, platelet transfusion and anhepatic phase≥100 min. Single factor analysis was performed to identify the potential risk factors of IPGF. Logistic regression analysis was conducted to explore independent risk factors. Results and Conclusions Child-Pugh C of preoperative recipient liver function, MELD score≥20, serum total bilirubin elevation(>68.4 μmol/L), hyponatremia(＜135 mmol/L), hypopotassaemia (＜3.5 mmol/L) and anhepatic phase≥100 min were potential risk factors of IPGF (all P＜0.05). Child-Pugh C of preoperative recipient liver function was an independent risk factor of the incidence rate of IPGF following living donor liver transplantation (P=0.019). -
表 1 两组供体和受体一般资料和临床数据的比较
Table 1. Comparison of general and clinical data of donors and recipients between two groups
指 标 IPGF组(n=37) 正常组(n=272) P值 供体因素 年龄(n) ＜49岁(n) 31 232 1.000 ≥49岁(n) 6 40 性别(n) 女 18 125 0.861 男 19 147 BMI(kg/m2,x±s) 23.2±2.7 22.8±2.6 0.314 ＜25 kg/m2(n) 29 221 0.824 ≥25 kg/m2(n) 8 51 受体因素 年龄 ＜16 岁(n) 7 53 16～49 岁(n) 21 176 0.418 ＞49岁(n) 9 43 性别(n) 0.833 女 9 59 男 28 213 BMI(kg/m2,x±s) 22±4 22±4 0.710 ＜25 kg/m2(n) 29 227 0.485 ≥25 kg/m2(n) 8 45 术前肝功能Child-Pugh C级(n) 20 54 ＜0.001 术前MELD 评分[分，(x±s)] 20±14 15±8 0.036 ＜20分(n) 21 209 0.009 ≥20分(n) 16 63 术前肾功能不全 阳性(n) 5 18 0.244 阴性(n) 32 254 术前血清总胆红素升高(n) 19 68 0.001 术前低钠血症(n) 13 36 0.002 术前低钾血症(n) 11 31 0.005 
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表 2 Logistic回归分析结果
Table 2. Results of Logistic regression analysis
变 量 B SE Wald χ2值 P值 Exp(B) 95% CI Lower Upper Child-Pugh C级 1.094 0.467 5.496 0.019 2.986 1.197 7.454 MELD评分≥20分 －0.105 0.482 0.047 0.828 0.900 0.350 2.316 术前总胆红素升高 0.411 0.498 0.681 0.409 1.509 0.568 4.006 术前低钠血症 0.26 0.486 0.287 0.592 1.298 0.500 3.368 术前低钾血症 0.812 0.445 3.328 0.068 2.252 0.941 5.388 无肝期≥100 min 0.636 0.378 2.822 0.093 1.888 0.899 3.964 注：CI为可信区间
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