成人尸体原位肝移植的远期死亡原因和危险因素分析

ANALYSIS OF THE CAUSES AND RISK FACTORS OF LATE MORTALITY IN ORTHOTOPIC LIVER TRANSPLANTATION IN ADULTS

目的成人尸体原位肝移植术后六月内死亡的常见原因是感染或者移植物衰竭,然而远期并发症导致死亡的原因尚未完全明朗。本研究目的是分析远期死亡的常见原因以及导致死亡的危险因素。方法 1991年10月-2003年4月间在香港大学玛丽医院为107例成人终末期肝病患者施行了112次尸体原位肝移植,对术后存活超过半年的远期死亡患者进行了分析(平均随访时间2．6年,范围0．5-11．2年);对供体、受体和手术等变量采用单变量(Cox回归)分析方法筛选肝移植术后远期死亡相关的危险因素。结果在研究期间112次移植共有34个移植物丧失(30．4％),其中有16个移植物在存活半年后丧失(14．3％)。总的1年、5年和10年移植物存活率分别是86．6％、73．3％和50．7％。远期死亡原因主要是感染(50％),器官功能衰竭(12．5％)。单变量分析法未能确定有意义的死亡危险因素。结论感染和器官功能衰竭是成人尸体原位肝移植远期死亡的主要原因,其远期死亡相关的危险因素尚不能确定。

Objective The most common causes of death within six months after orthotopic liver transplantation （OLTx）in adults are infection or graft failure. However,the causes leading to recipient death in the late stage after OLTx are still not to be elucidated. In this study,the most common causes and risk factors associated with late mortality after OLTx wre identified. Methods A total of 112 OLTx were performed in 107 adult patients with end-stage liver disease in the University of Hongkong Medical Centre between October 1991 and April 2003. All the patients died six months after OLTx were reviewed （mean follow-up 2.6 years,range 0.5～11.2）. Perioperative variables were analyzed using univariate techniques （cox regression）to indentify risk factors. Result 34 allografts （30. 4%） were lost in 112 OLTx during the study period. 16 allografts（14.3% ） were lost in the recipients who survived more than six months. The overall graft survival rates at 1 year,5 years and 10 years were 86. 6%, 73. 3% and 50. 7%,respectively. The main causes of late death were infection （50%） and organ failure（12.5%）. No perioperative variables were identified as risk factore for late death using univariate techniques in our single center. Conclusion Infection and organ failure were the major causes of late death among adult OLTx recipients. The risk factors associated with late mortality are not identified yet.