再次肝移植预后影响因素分析

Risk factors of liver retransplantation

目的统计分析天津市第一中心医院再次肝脏移植手术预后的影响因素，探讨提高再次移植术后生存率的对策。方法1999年1月至2006年12月施行再次肝脏移植手术132例，回顾性研究其中74例病例资料，对可能影响再次肝移植术后生存率的17个因素分析，采用Cox比例风险模型进行多因素分析，筛选出影响再次肝移植预后的显著相关因素。结果对17个可能影响再次肝移植预后的因素采用Kaplan—Meier方法单因素分析得出10个与再次肝脏移植术后生存率相关的变量：再次手术时期、肝性脑病、凝血酶原时间（PT）、总胆红素（TB）水平、热缺血时间、术式、术中出血量、术后ICU停留时间、术后感染及术后并发症。多因素分析进入Cox回归模型的有术式、术后ICU停留时间和术后并发症3个变量。结论影响再次肝移植预后的3个主要因素分别为手术方式、术后ICU停留时间和术后有无并发症的发生。

Objective To analyze the affecting factors for prognosis of the liver retransplantation in Tianjin First Central Hospital and explore the countermeasures for promoting survival rate after the operation. Methods The clinical data of 74 cases out of the 132 receiving liver retransplantation from January 1999 to December 2006 in our hospital were retrospectively analyzed. The Kaplan-Meier model was used in univariate analyses and Cox regression model in multivariate analysis to identify prognostic factors for survival. Results The following factors were identified as independent prognostic factors for survival by multivariate model： the duration of retransplantation, stage of hepatic encephalopathy, PT, TB, warm ischemia time, surgical procedure, hemorrhage during operation, days staying in the ICU and the development of sepsis and complications after retransplantation. Conclusion Operative surgical procedure, days staying in ICU and complications after the liver retransplantation provide significant predictive power after the operation.