脂肪变性供肝对成人肝移植早期预后的影响

The effect of fatty liver graft on early prognosis of post liver transplantation in adults

目的 探讨影响脂肪变性供肝在成人肝移植术后早期预后不良的相关危险因素.方法 回顾性分析2008年1月1日至2012年6月30日的脂肪肝供肝成人肝移植125例,根据术后早期预后分为预后不良组和非预后不良组,比较2组患者围手术期18项临床指标,进行单因素及多因素Logistic回归分析.结果 经单因素分析得出供肝脂肪变程度（x2=10.088,P=0.004）、受体年龄（t=-3.917,P=0.002）、术前肌酐值（Z=-2.623,P=0.009）、供肝热缺血时间（Z=-2.305,P=0.021）、冷缺血时间（Z=-3.394,P=0.001）5个指标差异有统计学意义（P＜0.05）;再对上述指标进行多元逐步Logistic回归分析,筛选出供肝冷缺血时间（x2=10.141,P=0.001,OR=1.003）、供肝脂肪变程度（x^2=8.360,P=0.004,OR=4.619）为独立危险因素,由此得出回归方程：Y=0.003×冷缺血时间＋ 1.530×脂肪变程度-4.243. 结论 供肝冷缺血时间、脂肪变程度是成人肝移植术后早期预后不良的独立危险因素.

Objective To investigate the effect of fatty liver graft on early poor prognosis in postoperative liver transplant adult patients.Methods The clinical data of 125 adult patients undergoing liver transplantation （LT） from fatty liver graft from January 2008 to October 2012 were retrospectively analyzed.Patients were divided into poor-prognosis group and non-poor-prognosis group.18 clinical factors were compared between these two groups by single factor and multiple factor Logistic regression analysis.Results Degree of steatosis （x2 =10.088,P =0.004）,recipients＆#39; age （t =-3.917,P =0.002）,pre-LTserum creatinine values （Z =-2.623,P =0.009）,liver warm ischemia time （Z =-2.305,P =0.021）,cold ischemia time （Z =-3.394,P =0.001） were identified to be statistically significant by the single factor analysis （P 〈 0.05）;By multivariate stepwise Logistic regression analysis on the above parameters,cold ischemia time （x2 =10.141,P =0.001,OR =1.003） and degree of steatosis （x2 =8.360,P =0.004,OR =4.619） were found as the independent risk factors,into the regression equation：Y =0.003 ＆#215; cold ischemia time ＋ 1.530 ＆#215; degree of steatosis-4.243.Conclusions Donor liver cold ischemia time,degree of steatosis are independent risk factors for poor prognosis in early stage after liver transplantation.