肝移植治疗终末期肝病合并门静脉高压症预后影响因素分析

Risk factor analysis of liver transplantation in the treatment of end-stage liver disease with portal hypertension

目的:肝脏移植手术已成为终末期肝病门静脉高压症的主要治疗手段,本文旨在研究分析肝脏移植手术治疗终末期肝病合并门静脉高压症病人的预后影响因素。方法:回顾性统计65例接受肝脏移植治疗的终末期肝病合并门静脉高压症病人的临床资料,包括年龄、原发疾病、术前门静脉高压症手术史、门静脉高压曲张静脉破裂出血、Child-Pugh分级、供体脂肪变性,及术后急性排异、重要脏器严重出血、感染、移植肝胆道血管并发症、原发疾病复发等。通过Logistic回归模型筛选出可能影响预后的危险因素。结果:供体脂肪变性(P=0.001)和重要脏器严重出血(P=0.009)是导致门静脉高压症病人肝脏移植术后死亡的主要危险因素。结论:在非紧急情况下避免使用边缘型供体,并积极防治术后严重出血,将能降低接受肝脏移植手术治疗的门静脉高压症病人的死亡率。

Objectives To explore the risks factor of liver transplantation in the treatment of end-stage liver disease with portal hypertension. Methods Clinical data from 65 patients with portal hypertension undergoing orthotropic liver transplantation （OLT） were studied retrospectively. The risk factors analyzed included age, primary liver diseases, pretransplantation portal hypertension opertatio（s）, preoperative varieeal bleeding, Child-pugh classification, status of steatosis of the donor liver, postoperative acute rejection, postoperative organ hemorrhage, infection, graft bile duct and vascular complications, and recurrence of the primary disease. Logistic regression model was applied to filtrate the possible risk factors. Results Status of steatosis of the donor liver （P=0.001） and postoperative organ hemorrhage（P=0.009） were the major risk factors influencing the prognosis of liver transplantation in the treatment of portal hypertension. Conclusions Avoiding the use of marginal donor in the nonemergent situation, as well as active prevention and treatment of postoperative massive organ hemorrhage will reduce the mortality rate of liver transplantation in the treatment of portal hypertension.