公民器官捐献供体质量对肝移植术后受体生存率的影响及其感染高危因素分析

Effect of donation after cardiac death donor quality on receptor survival rate after liver transplantation and analysis of risk factors of infection

目的探讨心脏死亡器官捐献(DCD)供体质量对肝移植术后受体生存率的影响,分析肝移植术后患者感染的因素。方法回顾性分析了2013年2月至2017年12月接受DCD肝脏移植手术患者102例,所有患者术后随访1年,分析DCD供体质量对肝移植术后患者生存率的影响,统计肝移植术后早期感染情况,分析影响感染的危险因素。结果本组死亡30例,死亡率29. 41%,单因素分析显示:肝移植术后死亡与DCD供体白蛋白、总胆红素、冷缺血时间、术中出血量、供体脂肪肝、肝细胞水肿有关(P <0. 05),多因素分析显示:冷缺血时间≥840 min(OR=3. 621,95%CI=0. 264～5. 619)、肝细胞脂肪变性(OR=2. 862,95%CI=0. 136～0. 769)是DCD肝移植术后响受体生存率的独立危险因素(P <0. 05)。本组肝移植术后感染38例,感染率37. 25%,单因素分析显示:肝移植术后感染与受体术前血红蛋白水平、血小板计数、Child-Pugh分级、术中红细胞输注量、ICU停留时间有关(P <0. 05),多因素分析显示:受体术前血红蛋白水平<120 g/L(OR=2. 310,95%CI=0. 681～1. 264)、术中红细胞输注量> 5U(OR=2. 862,95%CI=0. 136～0. 769)、ICU停留时间> 96 h(OR=3. 267,95%CI=0. 264～0. 961)是DCD肝移植术后受体感染的独立危险因素(P <0. 05)。结论 DCD冷缺血时间、肝细胞脂肪变性对肝移植术后受体生存有明显影响,受体术前贫血、术中失血程度、ICU停留时间均可影响术后感染的发生。

Objective To investigate the effect of donor cardiac donation( DCD) on the survival rate of recipients after liver transplantation,and to analyze the factors of infection after liver transplantation. Methods A retrospective analysis of 102 patients who underwent DCD liver transplantation. All patients were followed up for 1 year. The effect of DCD donor quality on survival rate after liver transplantation was analyzed. Statistical liver transplantation was performed. After the early infection,analyze the risk factors affecting the infection. Results 30 patients died in this group,the mortality rate was 29. 41%. Univariate analysis showed: death after liver transplantation and DCD donor albumin,total bilirubin,cold ischemia time,intraoperative blood loss,donor fatty liver,hepatocytes Related to edema( P < 0. 05). Multivariate analysis showed that cold ischemia time ≥840 min( OR = 3. 621,95% CI = 0. 264 - 5. 619),hepatic steatosis( OR = 2. 862,95% CI = 0. 136 - 0. 769) were independent risk factors for the survival rate of the rat after DCD liver transplantation( P < 0. 05). In this group,38 cases were infected after liver transplantation,and the infection rate was 37. 25%. Univariate analysis showed that preoperative hemoglobin level,platelet count,Child-Pugh classification,intraoperative red blood cell transfusion volume,ICU stay of infection and recipient after liver transplantation. Time-related( P < 0. 05). Multi-prime analysis showed that preoperative hemoglobin level < 120 g/L( OR = 2. 310,95% CI = 0. 681 - 1. 264),intraoperative red blood cell transfusion > 5 U( OR = 2. 862,95% CI = 0. 136 - 0. 769),ICU stay time > 96 h( OR = 3. 267,95% CI = 0. 264 - 0. 961) were independent risk of receptor infection after DCD liver transplantation factor( P < 0. 05). Conclusion DCD cold ischemia time and hepatic steatosis have significant effects on the survival of recipients after liver transplantation. The preoperative anemia,intraoperative blood loss and ICU stay time can affect the occurrence of postoperative infection.