儿童亲属活体肝移植术后中重度感染分析

Infections after pediatric living donor liver transplantation in 45 cases

目的分析儿童亲属活体肝移植术后中重度感染的特点及风险因素。方法对武警总医院2005年4月至2014年4月期间进行的45例儿童亲属活体肝移植的临床资料进行回顾分析，比较术后发生中重度感染和未发生者的区别。结果45例中27例患者术后出现84例次感染，主要为细菌感染（25例）、病毒感染（14例）、白色念珠菌感染（3例）。移植术后3个月内主要为细菌感染，3个月后主要为病毒和真菌感染。术后3个月内感染的80％（16／20）患者他克莫司浓度在目标范围，余4例患者他克莫司浓度超过10μg／L。3个月后感染的75％（12／16）患者他克莫司浓度超过10μg／L，差异有统计学意义（P〈O．05）。感染组和非感染组间体质量〈10kg、月龄〈12个月、胆肠吻合、儿童终末期肝病模型（PELD）评分、Child-Pugh评分、血胆红素、术中每kg体质量失血量以及移植物质量／受者体质量的差异有统计学意义（P〈0．05）。Logistic回归分析显示，术前PELD评分为术后感染的独立性风险因素。结论儿童亲属活体肝移植术后感染具有自身特点，应该重视对感染风险因素的控制，合理应用免疫抑制剂，以降低移植术后感染的发生率。

Objective To investigate the characteristics of infection and risk factors after pediatric living donor liver transplantation （PLDLT）. Method Form April 2005 to April 2014 the clinical data of 45 cases of PLDLT in General Hospital of Chinese People＇s Armed Police Forces were retrospectively investigated, and the difference between the patients after PLDLT with infection and those without infection was analyze＆ Result Eighty-four infections occurred in 27 （60. 0%） of 45 patients, including 25 cases of bacterial infections, 14 cases of viral infections, and 3 cases of eandida albicans infections. Most infections occurring within 3 months after PLDLT have been found to be caused by bacteria, viruses and fungi. The trough level of tacrolimus （Tac） was in target therapeutic window in 16/20 infected patients and more than 10 ng/mL in 4/20 infected patients within 3 months after PLDLT, and there were 12/16 infected patients with the trough level of Tac of more than 10 ng/ mL 3 months post-PLDLT, with the difference being significant （P〈0. 05）. Multivariate analysis revealed that post-transplant infection was significantly related with the factors as weight〈10 kg, age 〈12 months, biliary intestinal anastomosis, pediatric end-stage liver disease （PELD） score, Child- Pugh score, total bilirubin, blood loss per kg body weight and graft to recipient weight ratio （GRWR）. Logistic regression analysis suggested that PELD score was independent risk factor of infection after PLDLT. Conclusion The infection after PLDLT has their special characteristics. The proper immunosuppressive protocol and control of above risk factors are helpful to decrease the incidence of infection after PLDLT.