心脏死亡器官捐赠供受者术前及术后早期临床指标对肝移植预后的影响

Liver transplantation with donation after cardiac death donors： risk factors for recipient survival

目的探讨心脏死亡器官捐赠（DCD）供受者术前及术后早期各项临床指标对受者预后的影响。方法回顾性分析60例DCD肝移植供受者的临床资料。术前指标包括：供者年龄、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）；受者年龄、血肌酐、胆红素总量（TBi1）、国际标准化比值（INR）、白蛋白、终末期肝病模型（MELD）评分、体质量指数；供肝热缺血时间和冷缺血时间。将术后72h内ALT或（和）AST〉1500U／L定义为术后早期肝功能恢复不良。应用Kaplan-Meier法对受者总体存活进行生存分析，应用log-rank检验进行存活影响因素的单因素分析，进一步应用多因素COX比例风险回归模型筛选独立影响因素。结果60例DCD肝移植受者1和3年累积存活率分别为76％和62％。供者术前ALT、AST、供肝热缺血时间以及受者术前肌酐、MELD评分、供肝冷缺血时间、术后早期肝功能恢复不良的发生为受者预后的单因素分析影响因素。进一步筛选出热缺血时间（相对危险度=1．318，95％可信区间为1．1731．481，P=0．000）为DCD肝移植受者预后的独立影响因素。结论DCD供肝热缺血时间为影响肝移植受者预后的独立影响因素，控制热缺血时间有利于改善DCD受者的预后。

Objective To analyze the risk factors for the outcomes of recipients after orthotopic liver transplantation using donation after cardiac death （DCD） donors. Method A retrospective study was performed to observe the available clinical data of 60 patients who had receiced hepatic allografts of DCD donors from July 2007 to December 2012 in our hospital and a 3-year follow-up was conducted to investigate outcome. In the patients whose ALT and/or AST levels were more than 1500 U/L within 72 h following surgery, early allograft dysfunction （EAD） was defined. Potential risk fators right before surgery included donor and recipient age, donor ALT AST, TBIL and WIT, and recipient creatine, TBIL, INR, albumin, MELD, BMI and recipient CIT. Kaplan-meier method was used to calculate the cumulative survival rate. Log-rank test and Cox regression model were performed to analyze donors and recipients related risk factors by univariate and multivariate analysis respectively. All statistical data were analyzed by using SPSS 19. 0. Results The overall cumulative survival rate of 1 and 3 years was 76% and 62% respectively. Donor ALT, AST and WIT, and recipient Cre, MELD, CIT and EAD were significant risk fators in univariate analysis. However, the multivariate analysis revealed that donor WIT was the only independent risk factor affecting survival in our study. Conclusion By identifying and controlling certain characteristics, the outcomes of DCD liver transplant recipients could be dramaticly improved.