成人良性终末期肝病肝移植术后中远期死亡的危险因素分析

Risk factors predicting late mortality after liver transplantation for benign end-stage liver disease

目的 了解成人良性终末期肝病肝移植患者术后中远期的生存情况和导致中远期生存率下降的危险因素.方法 回顾性分析2003年10月至2007年6月行原位肝移植手术且术后存活时间超过1年的221例良性终末期肝病受者的资料,选取包括受者术前变量、供者变量、术中变量和受者术后变量共26个可能影响患者长期存活的危险因素,采用Cox回归分析筛选出影响肝移植受者术后长期存活的独立危险因素.结果 221例受者的随访率为97.3%（215/221）,平均随访时间为（36.4±6.9）个月（12～56个月）.其中28例在术后1年后死亡,主要死亡原因依次为感染（5.0%,11/221）、胆道并发症（3.6%,8/221）、乙型肝炎复发或再感染（1.4%,3/221）.保留在Cox回归方程内的协变量为高龄（RR=2.325,P=0.009）、ABO血型（RR=2.206,P=0.015）、冷缺血时间（RR=3.001,P=0.000）、术后感染部位（RR=1.665,P=0.007）和胆道并发症（RR=2.655,P=0.004）.结论 影响受者术后中远期存活的危险因素包括年龄≥60岁、ABO血型不符、冷缺血时间〉12 h、术后肺部感染和移植肝胆管弥漫性狭窄.

Objectives To find out the risk factors predicting long-term survival,and to explore the measures for further improving the survival outcome of whom underwent liver transplantation （ LT） for benign end-stage liver disease. Methods The common causes of late death after LT and risk factors were retrospectively analyzed in 221 consecutive patients, who underwent LT from October 2003 to June 2007 and survived more than one year. Twenty-six potential risk factors were assessed by the Kaplan-Meier method, and those variables found to be univariately significant at P 〈 0. 10 were entered into a backward step down Cox proportional hazard regression analysis to screen the independent risk factors influencing the recipient＇s long-term survival. Results There were 28 recipients died one year later after LT during the follow-up period. The major causes of late mortality were related to infectious complications 5. 0% （11/221） , biliary complications 3. 6% （8/221） and HBV recurrence/reinfection 1.4% （ 3/221 ）. After Cox proportional hazard regression analysis, 5 covariables finally retained in the formula were： age （ RR = 2. 325, P = 0.009） ,ABO blood group （RR = 2. 206,P =0. 015）,cold ischemia time （RR =3.001 ,P =0.000）,postinfection region （ RR = 1. 665, P =0. 007 ） and biliary complications （RR = 2. 655, P = 0. 004）. Conclusion Age （≥60 years）, ABO blood group （incompatible） ,cold ischemia time （ 〉 12 h） .infectious complications （lung infection） and biliary complications （diffuse biliary stricture） significantly impact patient＇s survival time.