儿童心脏死亡器官捐献供肝移植术后早期肝动脉血栓危险因素分析’

Risk factors for early hepatic artery thrombosis after liver transplantation from donation afier cardiac death in children

目的分析儿童心脏死亡器官捐献（DCD）供肝肝移植术后早期肝动脉血栓（Hepatic artery thrombosis，HAT）发生的危险因素。方法收集天津市第一中心医院2013年2月至2015年4月施行的48例儿童DCD肝移植手术的临床资料，回顾分析临床因素对受者早期HAT的影响。结果48例不区分年龄的儿童DCD肝移植受者术后共8例发生早期HAT,发生率为16．6％。其单因素分析显示HAT组与对照组间的术前Cr（P=0．043）、Child-Pugh评分（P=0．041）、热缺血时间（P=0．022）、受体性别（P=0．045）的差异有统计学意义（P〈0．05），多因素分析显示热缺血时间（P=0．03）、受体性别（p=0．039）是其术后早期HAT的独立危险因素。48例患儿中≤1岁的儿童有33例，其中6例发生早期HAT，发生率为18．2％。对其进行单因素分析显示HAT组与对照组间的受体年龄（P=0．045）、受体性别（P=0．013）、受体身高（P=0．034）、术前Cr（P=0．034）、术前TB（P=0．015）、Child-Pugh评分（P=0．007）、热缺血时间（P=0．001）的差异有统计学意义（P〈0．05），多因素分析显示热缺血时间（P=0．015）、受体身高（P=0．016）是其术后早期HAT的独立危险因素。结论HAT仍然是儿童DCD肝移植术后的重要难题，对供者、受者的选择以及对供肝获取和植入技术的深入研究将会有助于降低儿童DCD供肝肝移植术后早期HAT发生的概率。

Objective To explore the risk factors of hepatic artery thrombosis （HAT） of liver transplantation from donation after cardiac death （DCD） in children. Methods The clinical data were studied retrospectively for 48 children undergoing liver transplantation from DCD at First Municipal Central Hospital from February 2013 to April 2015. The risk factors of HAT after pediatric liver transplantation from DCD were analyzed. Results Eight （16. 6%） children developed HAT after DCD liver transplantation. Univariate analysis showed that HAT was associated with preoperative creatinine （P = 0. 043）, Child-Pugh score （P = 0. 041）, warm ischemic duration （P = 0. 022） and recipient gender （P = 0. 045）. And multivariate analysis indicated that warm ischemic duration （P = 0. 03） and recipient gender （P = 0. 039） were independent risk factors forpredicting HAT. And 6/33 children aged under 1 year （18. 2~） developed HAT. Univariate analysis showed that HAT was associated with recipient age （P = 0. 045）, recipient gender （P = 0. 013）, recipient height （P = 0. 034）, preoperative creatinine （P = 0. 034）, TB （P = 0. 015）, Child-Pugh score （P = 0. 007） and warm ischemic duration （P = 0. 001）. And multivariate analysis indicated that warm ischemic duration （P = 0. 015） and recipient height （P = 0. 016） were independent risk factors for predicting HAT. Conclusions Selecting donors recipients and refining transplantation techniques shall lower the occurrences of HAT during early postoperative period.