Analysis of early prognosis and risk factors of donor liver with moderate-to-severe steatosis in adult liver transplantation
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摘要:
目的 探讨中重度脂肪变性供肝肝移植受者的早期预后及其发生移植物功能延迟恢复(DGF)的危险因素。 方法 回顾性分析公民逝世后器官捐献供肝肝移植供、受者各475例的临床资料,根据澳大利亚国家肝移植中心(ANLTU)脂肪变性供肝分级,将接受相应供肝的受者分为S0组(无脂肪变性,308例)、S1组(轻度脂肪变性,97例)、S2组(中度脂肪变性,52例)、S3组(重度脂肪变性,18例)4组。比较各组受者术后早期死亡及并发症发生情况,对可能导致受者发生DGF的供者因素、受者因素、手术因素进行单因素及多因素logistic回归分析。 结果 S2组及S3组术后DGF的发生率高于S1组及S0组(均为P < 0.05),S3组术后DGF发生率高于S2组(P < 0.05);各组受者的术后早期病死率,移植肝原发性无功能(PNF)、术后出血、感染、胆道并发症和血管并发症的发生率等指标,差异均无统计学意义(均为P > 0.05)。单因素分析结果提示,供者供肝脂肪变性程度较严重、冷缺血时间长和受者术前终末期肝病模型(MELD)评分高、存在肿瘤是发生DGF的危险因素,差异均有统计学意义(均为P < 0.05)。多因素logistic回归分析结果提示,供者供肝中重度脂肪变性、冷缺血时间 > 8 h及受者MELD评分 > 30分是术后早期发生DGF的独立危险因素。 结论 中重度脂肪变性供肝应用于成人肝移植术后早期易发生DGF,但不影响受者术后早期生存率。对于中重度脂肪变性供肝的选用应结合供者冷缺血时间及受者术前MELD评分等因素综合考虑。 Abstract:Objective To explore the early prognosis and the risk factors of delayed graft function (DGF) of the recipients undergoing liver transplantation from donor liver with moderate-to-severe steatosis. Methods Clinical data of 475 donors and 475 recipients undergoing liver transplantation from donor liver of organ donation after citizen's death were retrospectively analyzed. According to the classification criteria of steatosis proposed by Australia National Liver Transplantation Unit (ANLTU), all recipients were divided into the S0 group (no steatosis, n=308), S1 group (mild steatosis, n=97), S2 group (moderate steatosis, n=52) and S3 group (severe steatosis, n=18), respectively. The early postoperative death and incidence of postoperative complications were statistically compared among each group. The risk factors from donors, recipients and operation leading to DGF were analyzed by univariate and multivariate logistic regression models. Results The incidence of postoperative DGF in the S2 and S3 groups was significantly higher than that in the S1 and S0 groups (all P < 0.05). The incidence of postoperative DGF in the S3 group was remarkably higher than that in the S2 group (P < 0.05). The early postoperative fatality, the incidence of primary nonfunction (PNF) of the transplant liver, postoperative bleeding, infection, biliary complications and vascular complications did not significantly differ among each group (all P > 0.05). Univariate regression analysis showed that severe steatosis of donor liver, long cold ischemia time, high model for end-stage liver disease (MELD) score and tumors of the recipients before operation were the risk factors of DGF (all P < 0.05). Multivariate logistic regression analysis demonstrated that moderate-to-severe steatosis of donor liver, cold ischemia time > 8 h and MELD score > 30 of the recipients were the independent risk factors for early postoperative DGF. Conclusions The early-stage incidence of DGF after adult liver transplantation from donor liver with moderate-to-severe steatosis is high, whereas it does not affect the early survival rate of the recipients. The selection of donor liver with moderate-to-severe steatosis should be considered in combination with cold ischemia time of the donors and MELD score of the recipients before operation, etc. -
表 1 各组受者术后早期死亡及并发症发生情况
Table 1. The occurrence of early postoperative death and complications of recipients among each group [n (%)]
组别 n 死亡 PNF 排斥反应 DGF 胆道并发症 血管并发症 围手术期感染 术后出血 S0 308 9(3) 0(0) 6(2) 34(11) 22(7) 5(2) 74(24) 9(3) S1 97 2(2) 1(1) 1(1) 15(15) 7(7) 2(2) 26(27) 2(2) S2 52 2(4) 0(0) 0(0) 26(50)a, b 3(6) 1(2) 8(15) 2(4) S3 18 1(6) 0(0) 0(0) 13(72)a, b, c 1(6) 0(0) 3(17) 0(0) P值 0.298 0.876 0.745 0.002 0.089 0.478 0.342 0.572 注:与S0组比较,aP < 0.05;与S1组比较,bP < 0.05;与S2组比较,cP < 0.05。 表 2 肝移植术后早期发生DGF的危险因素的单因素分析
Table 2. Univariate analysis of the risk factors of DGF in early stage after liver transplantation
变量 DGF P值 有(n=88) 否(n=387) 供者因素 供肝脂肪变性程度[n(%)] <0.05 S0 34(11) 274(89) S1 15(15) 82(85) S2 26(50) 26(50) S3 13(72) 5(18) 年龄(x±s, 岁) 41±5 38±7 >0.05 性别[n(%)] >0.05 男 84(95) 371(96) 女 4(5) 16(4) 热缺血时间(x±s, min) 8.9 ±2.9 6.3 ±2.2 >0.05 冷缺血时间[n(%)] <8 h 17(19) 237(61) <0.05 8~12 h 41(47) 111(29) >12 h 30(34) 39(10) 血清钠(x±s, mmol/L) 142.1±3.4 139.8±2.7 >0.05 血型不相容[n(%)] 8(9) 25(6) >0.05 外科创伤[n(%)] 37(42) 137(35) >0.05 ICU住院时间[M(Q), d] 5.8(3.1) 4.9(1.2) >0.05 受者因素 年龄(x±s, 岁) 52±9 50±7 >0.05 术前MELD评分[n(%)] <30分 41(47) 266(69) <0.05 ≥30分 47(53) 121(31) 性别[n(%)] >0.05 男 65(74) 330(85) 女 23(26) 57(15) 存在肿瘤[n(%)] 24(27) 59(15) <0.05 手术因素 手术时间(x±s, h) 7.3±2.4 7.9±2.2 >0.05 术中失血量[M(Q), mL] 1 893(582) 1 690(621) >0.05 术中输液量[M(Q), mL] 4 387(1 034) 4 290(1 278) >0.05 术中尿量[M(Q), mL] 1 673(518) 1 987(498) >0.05 表 3 肝移植术后早期发生DGF的危险因素的多因素logistic回归分析
Table 3. Multivariate logistic regression analysis of the risk factors of DGF in early stage after liver transplantation
变量 OR①(95% CI②) P值 供者因素 供肝脂肪变性程度 S0 1 S1 1.58(0.39~6.45) 0.135 S2 4.17(1.04~27.43) 0.017 S3 3.34(1.40~17.07) 0.035 冷缺血时间 <8 h 1 8~12 h 2.19(1.07~5.96) 0.034 >12 h 2.98(1.08~37.02) 0.005 受者因素 术前MELD评分 <30分 1 ≥30分 2.49(1.01~6.28) 0.042 存在肿瘤 有 1 否 1.43(0.47~5.00) 0.574 注:①OR为比值比。
②CI为可信区间。 -
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