留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

感染性供者器官安全应用分析

何莉 栗光明 林栋栋 刘晋宁 王鑫 许瀛

何莉, 栗光明, 林栋栋, 等. 感染性供者器官安全应用分析[J]. 器官移植, 2019, 10(6): 702-707. doi: 10.3969/j.issn.1674-7445.2019.06.012
引用本文: 何莉, 栗光明, 林栋栋, 等. 感染性供者器官安全应用分析[J]. 器官移植, 2019, 10(6): 702-707. doi: 10.3969/j.issn.1674-7445.2019.06.012
He Li, Li Guangming, Lin Dongdong, et al. Safety application of organs from infectious donors[J]. ORGAN TRANSPLANTATION, 2019, 10(6): 702-707. doi: 10.3969/j.issn.1674-7445.2019.06.012
Citation: He Li, Li Guangming, Lin Dongdong, et al. Safety application of organs from infectious donors[J]. ORGAN TRANSPLANTATION, 2019, 10(6): 702-707. doi: 10.3969/j.issn.1674-7445.2019.06.012

感染性供者器官安全应用分析

doi: 10.3969/j.issn.1674-7445.2019.06.012
基金项目: 

首都临床特色应用研究与成果推广 Z171100001017035

首都医科大学附属北京佑安医院2018年度院内中青年人才孵育项目 YNKTTS20180124

详细信息
    作者简介:

    何莉,女,1989年生,硕士,住院医师,研究方向为供体器官维护及肝移植围手术期管理,Email:helily0029@163.com

    通讯作者:

    栗光明,男,1967年生,博士,主任医师,研究方向为肝胆外科疾病诊疗及肝移植,Email:liguangming917@163.com

  • 中图分类号: R617, R619+.3

Safety application of organs from infectious donors

More Information
  • 摘要:   目的  探讨应用感染性供者器官的安全性。  方法  回顾性分析67例行同种异体原位肝移植术的供、受者临床资料。根据供者是否存在感染及感染部位将受者分为3组, 血流感染组(供者非耐药菌感染, 16例)、非血流感染组(供者血流以外部位存在感染, 20例)和未感染组(31例)。比较3组受者围手术期临床指标, 包括术前终末期肝病模型(MELD)评分、手术时间、无肝期、术中出血量、术中输血量; 观察受者术后1、3、7、14、21 d肝功能及凝血功能恢复情况; 记录受者肝移植术后1个月内的并发症发生率及病死率; 观察受者术后感染指标恢复情况, 包括白细胞(WBC)、中性粒细胞百分比(NE%)、降钙素原(PCT)。记录受者限制级别抗生素应用率及应用时间。  结果  3组受者围手术期临床指标的差异均无统计学意义(均为P > 0.05)。3组受者术后各时间点的肝功能、凝血功能、并发症发生率及病死率差异均无统计学意义(均为P > 0.05)。血流感染组受者术后3、7 d的NE%明显高于非血流感染组和未感染组受者(均为P < 0.05), 血流感染组受者术后3、7、14 d的PCT明显高于非血流感染组和未感染组受者(均为P < 0.05)。血流感染组受者的限制级抗生素使用率、使用时间均明显高于或长于非血流感染组和未感染组受者(均为P < 0.05)。  结论  在尽早应用抗生素的前提下, 应用非耐药菌血流感染或其他局部感染捐献者的供肝是安全的。

     

  • 图  1  3组肝移植受者的肝功能及凝血功能情况

    Figure  1.  Liver function and coagulation function of liver transplant recipients in 3 groups

    图  2  3组肝移植受者术后感染指标

    与非血流感染组比较,aP < 0.05;与未感染组比较,bP < 0.05

    Figure  2.  Postoperative infection indicators of liver transplantation recipients in 3 groups

    表  1  3组肝移植受者围手术期情况比较

    Table  1.   Comparison of perioperative status of liver transplantation recipients among 3 groups

    组别 n MELD评分
    [M(R), 分]
    手术时间
    x±s, min)
    无肝期
    x±s, min)
    术中出血量
    [M(R), mL]
    术中输血量
    [M(R), mL]
    血流感染组 16 10(33) 482±58 69±11 1 200(3 100) 1 200(4 000)
    非血流感染组 20 8(42) 496±82 69±9 1 500(4 400) 1 600(4 000)
    未感染组 31 9(40) 498±79 68±7 1 600(4 600) 1 600(3 600)
    统计值 0.194 0.245 0.210 1.098 0.601
    P 0.824 0.784 0.811 0.340 0.552
    下载: 导出CSV

    表  2  3组肝移植受者术后1个月并发症及死亡情况

    Table  2.   Complications and death of liver transplant recipients in 3 groups within 1 month after operation[n(%)]

    组别 n ARDS AKI DGF 感染 死亡
    血流感染组 16 2(13) 3(19) 2(13) 6(38) 2(13)
    非血流感染组 20 2(10) 2(10) 3(15) 4(20) 1(5)
    未感染组 31 4(13) 5(16) 4(13) 4(13) 1(3)
    P 0.897 0.937 0.947 0.263 0.435
    下载: 导出CSV
  • [1] WOLACH B, SAZBON L, GAVRIELI R, et al. Early immunological defects in comatose patients after acute brain injury[J]. J Neurosurg, 2001, 94(5):706-711. doi: 10.3171/jns.2001.94.5.0706
    [2] MOHAREM HA, FETOUH FA, DARWISH HM, et al. Effects of bacterial translocation on hemodynamic and coagulation parameters during living-donor liver transplant[J]. BMC Anesthesiol, 2018, 18(1):46. DOI: 10.1186/s12871-018-0507-7.
    [3] CHONG PP, RAZONABLE RR. Diagnostic and management strategies for donor-derived infections[J]. Infect Dis Clin North Am, 2013, 27(2):253-270. DOI: 10.1016/j.idc.2013.02.001.
    [4] LEWIS JD, SIFRI CD. Multidrug-resistant bacterial donor-derived infections in solid organ transplantation[J]. Curr Infect Dis Rep, 2016, 18(6):18. DOI: 10.1007/s11908-016-0526-9.
    [5] HU FP, GUO Y, ZHU DM, et al. Resistance trends among clinical isolates in China reported from CHINET surveillance of bacterial resistance, 2005-2014[J]. Clin Microbiol Infect, 2016, 22(Suppl 1): S9-S14. DOI: 10.1016/j.cmi.2016.01.001.
    [6] VAN DUIN D, VAN DELDEN C, AST Infectious Diseases Community of Practice. Multidrug-resistant gram-negative bacteria infections in solid organ transplantation[J]. Am J Transplant, 2013, 13 (Suppl 4): 31-41. DOI: 10.1111/ajt.12096.
    [7] GOLDBERG E, BISHARA J, LEV S, et al. Organ transplantation from a donor colonized with a multidrug-resistant organism: a case report[J]. Transpl Infect Dis, 2012, 14(3):296-299. DOI: 10.1111/j.1399-3062. 2011.00697.x.
    [8] SIMKINS J, MUGGIA V. Favorable outcome in a renal transplant recipient with donor-derived infection due to multidrug-resistant pseudomonas aeruginosa[J]. Transpl Infect Dis, 2012, 14(3):292-295. DOI: 10.1111/j.1399-3062.2011.00674.x.
    [9] SINGH N, HUPRIKAR S, BURDETTE SD, et al. Donor-derived fungal infections in organ transplant recipients: guidelines of the American Society of Transplantation, infectious diseases community of practice[J]. Am J Transplant, 2012, 12(9):2414-2428. DOI: 10.1111/j.1600-6143.2012.04100.x.
    [10] 丁利民, 徐志丹, 李新长, 等.公民逝世后器官捐献供肝保护及功能评估临床分析[J].器官移植, 2017, 8(6):430-434. DOI: 10.3969/j.issn.1674-7445.2017.06.004.

    DING LM, XU ZD, LI XC, et al. Clinical analysis on donor liver protection and function evaluation for organ donation after citizen' s death[J]. Organ Transplant, 2017, 8(6):430-434. DOI:10.3969/j.issn. 1674-7445.2017.06.004.
    [11] NELLORE A, FISHMAN JA. Donor-derived infections and infectious risk in xenotransplantation and allotransplantation[J]. Xenotransplantation, 2018, 25(4):e12423. DOI: 10.1111/xen.12423.
    [12] BENAMU E, WOLFE CR, MONTOYA JG. Donor-derived infections in solid organ transplant patients: toward a holistic approach[J]. Curr Opin Infect Dis, 2017, 30(4):329-339. DOI: 10.1097/QCO.0000000000000377.
    [13] FISCHER SA. Is this organ donor safe?: donor-derived infections in solid organ transplantation[J]. Infect Dis Clin North Am, 2018, 32(3):495-506. DOI: 10.1016/j.idc.2018.04.001.
    [14] 王婷婷, 孔心涓, 饶伟.边缘性供肝移植术后早期肝功能不全影响因素的研究进展[J/CD].实用器官移植电子杂志, 2016, 4(5): 302-305. DOI: 10.3969/j.issn.2095-5332.2016.05.010.

    WANG TT, KONG XJ, RAO W, et al. Research progress on factors affecting early liver dysfunction after marginal donor liver transplantation[J/CD]. Pract J Organ Transplant (Electr Vers), 2016, 4(5): 302-305. DOI: 10.3969/j.issn.2095-5332.2016.05.010.
    [15] PITOUT JD, NORDMANN P, POIREL L. Carbapenemase- producing Klebsiella pneumoniae, a key pathogen set for global nosocomial dominance[J]. Antimicrob Agents Chemother, 2015, 59(10):5873-5884. DOI:10.1128/AAC. 01019-15.
    [16] 中华医学会器官移植学分会, 中华预防医学会医院感染控制学分会, 复旦大学华山医院抗生素研究所.中国实体器官移植供者来源感染防控专家共识(2018版)[J].中华器官移植杂志, 2018, 39(1):41-52. DOI: 10.3760/cma.j.issn.0254-1785.2018.01.008.

    Branch of Organ Transplantation of Chinese Medical Association, Branch of Nosocomial Infection Control of Chinese Preventive Medical Association, Antibiotic Research Institute of Fushan University Huashan Hospital. Expert consensus on prevention and control of Chinese solid organ transplant donor source infection (2018 edition)[J]. Chin J Organ Transplant, 2018, 39(1):41-52. DOI: 10.3760/cma.j.issn.0254-1785.2018.01.008.
    [17] AIRES-DE-SOUSA M, ORTIZ DE LA ROSA JM, GONÇALVES ML, et al. Epidemiology of carbapenemase-producing Klebsiella pneumoniae in a hospital, Portugal[J]. Emerg Infect Dis, 2019, 25(9):1632-1638. DOI: 10.3201/eid2509.190656.
    [18] CAMPOS AC, ALBIERO J, ECKER AB, et al. Outbreak of klebsiella pneumoniae carbapenemase-producing K pneumoniae: a systematic review[J]. Am J Infect Control, 2016, 44(11):1374-1380. DOI: 10.1016/j.ajic. 2016.03.022.
    [19] COHEN J, MICHOWIZ R, ASHKENAZI T, et al. Successful organ transplantation from donors with acinetobacter baumannii septic shock[J]. Transplantation, 2006, 81(6):853-855. doi: 10.1097/01.tp.0000203804.95180.6e
    [20] ISON MG, GROSSI P, AST Infectious Diseases Community of Practice. Donor-derived infections in solid organ transplantation[J]. Am J Transplant, 2013, 13 (Suppl 4):22-30. DOI: 10.1111/ajt.12095.
    [21] WAN Q, LIU H, YE S, et al. Confirmed transmission of bacterial or fungal infection to kidney transplant recipients from donated after cardiac death (DCD) donors in China: a single-center analysis[J]. Med Sci Monit, 2017, 23:3770-3779. doi: 10.12659/MSM.901884
    [22] 陈小松, 韩龙志, 钱永兵, 等.供体来源碳青霉烯酶类耐药肺炎克雷伯杆菌感染--肝肾移植的差异[J/CD].实用器官移植电子杂志, 2018, 6(1): 45-48. DOI: 10.3969/j.issn.2095-5332.2018.01.011.

    CHEN XS, HAN LZ, QIAN YB, et al. The difference between liver and kidney transplantation--donor derived infection of carbapenemresistant Klebsiella pneumonia[J/CD]. Pract J Organ Transplant (Electr Vers), 2018, 6(1): 45-48. DOI: 10.3969/j.issn.2095-5332.2018.01.011.
    [23] KARAISKOS I, ANTONIADOU A, GIAMARELLOU H. Combination therapy for extensively-drug resistant gram-negative bacteria[J]. Expert Rev Anti Infect Ther, 2017, 15(12):1123-1140. DOI:10.1080/14787210.2017. 1410434.
    [24] GARBER K. A β-lactamase inhibitor revival provides new hope for old antibiotics[J]. Nat Rev Drug Discov, 2015, 14(7):445-447. DOI: 10.1038/nrd4666.
    [25] TUMBARELLO M, TRECARICHI EM, CORONA A, et al. Efficacy of ceftazidime-avibactam salvage therapy in patients with infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae[J]. Clin Infect Dis, 2019, 68(3):355-364. DOI: 10.1093/cid/ciy492.
  • 加载中
图(2) / 表(2)
计量
  • 文章访问数:  134
  • HTML全文浏览量:  56
  • PDF下载量:  12
  • 被引次数: 0
出版历程
  • 收稿日期:  2019-09-03
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2019-11-15

目录

    /

    返回文章
    返回