儿童DCD供肝肝移植术后胆道并发症高危因素研究

Risk factors for biliary complications after pediatric liver transplantation from donation after cardiac death

目的分析儿童心脏死亡器官捐献（DCD）肝移植受者术后胆道并发症发生的高危因素。方法收集天津市第一中心医院2013年3月至2015年3月施行的48例儿童DCD肝移植手术的临床资料，回顾性分析临床因素对受者胆道并发症的影响。结果48例儿童DCD肝移植受者术后共11例发生胆道并发症，发生率为22．9％。单因素分析显示胆道并发症组与对照组间的热缺血时间（P=0．003）差异有统计学意义（P〈0．05），受体年龄（P=0．998）、受体性别（P=0．094）、MELD评分（P=0．159）、PELD评分（P=0．740）、Child-Pugh评分（P=0．159）、冷缺血时间（P=0．990）、受体ICU逗留时间（P=0．105）、是否发生感染（P=0．930）、有无其他并发症（门静脉狭窄／血栓形成、肝动脉栓塞、DGF）（P=0．268）以及AB0血型是否相容（P=1．106）差异无统计学意义（P〉0．05）。多因素分析显示热缺血时间（P=0．020，OR=10．367，95％可信区间为1．451-74．089）是术后胆道并发症的独立危险因素。结论胆道并发症仍然是儿童DCD肝移植术后的重要难题，热缺血时间是受者术后胆道并发症的独立危险因素。因此选择更短热缺血时间的CDC供肝可以降低儿童肝移植受者胆道并发症的发生率。

Objective To explore the risk factors of biliary complications of pediatric liver transplantation from donation after cardiac death （DCD）. Methods The clinical data of 48 cases of pediatric liver transplantation from DCD at First Municipal Central Hospital from March 2013 to March 2015 were retrospectively collected and reviewed. And the risk factors of biliary complications after pediatric liver transplantation from DCD were analyzed. Results Eleven （22. 9%） pediatric patients developed biliary complications after transplantation. Univariate analysis showed that biliary complications were associated with warm ischemic time （P = 0. 003）, but not with recipient age （P = 0. 998）, recipient gender （P = 0. 094）, MELD score （P = 0. 159）, PELD score （P = 0. 740）, Child-Pugh （P = 0. 990） ,cold ischemic time （P = 0. 990）, length of ICU stay （P = 0. 105）, infection or not （P = 0. 930） ,other complications （P = 0. 268） or ABO blood type matching （P = 1. 106）. Multivariate analysis showed that warm ischernic time （P = 0. 020, OR = 10. 367,95 % confidence interval 1.451 to 74. 089） was an independent prognostic risk factor for biliary complications. Conclusions Warm ischemic time is an independent prognostic risk factor for postoperative biliary complications. Thus shorter warm ischemic time of DCD donor may reduce the incidence of biliary complications after pediatric liver transplantation.