供体风险指数对慢加急性肝衰竭肝移植治疗早期预后的影响:单中心159例经验

Effect of donor risk index on early prognosis of liver transplantation for acute-on-chronic liver failure: experience of 159 cases in one single center

目的探讨供体的供体风险指数(DRI)对慢加急性肝衰竭(ACLF)行肝移植治疗早期预后的影响。方法回顾性分析接受肝移植治疗的159例ACLF受体临床资料,根据供体DRI计算公式将受体分为DRI<1.65组(96例)和DRI≥1.65组(63例);根据慢性肝衰竭联盟-慢加急性肝衰竭评分(CLIF-C ACLFs),将受体分为CLIF-C ACLFs<48组(78例)和CLIF-C ACLFs≥48组(81例)。分别观察各组受体肝移植术后早期预后指标[重症监护室(ICU)住院时间、术后住院时间]。应用Kaplan-Meier生存曲线分析受体肝移植术后90 d生存率,应用Cox比例风险回归模型分析影响ACLF受体肝移植术后早期预后的危险因素。结果 DRI<1.65组与DRI≥1.65组的ICU住院时间、术后住院时间比较,差异均无统计学意义(均为P>0.05)。CLIF-C ACLFs <48组和CLIF-C ACLFs≥48组术后住院时间比较,差异无统计学意义(P>0.05)。CLIF-C ACLFs<48组的ICU住院时间为4(3～14)d,明显短于CLIF-C ACLFs≥48组的7(1～33) d(P<0.05)。CLIF-C ACLFs评分是影响ACLF受体肝移植术后早期预后的危险因素(P<0.05)。DRI<1.65组与DRI≥1.65组的术后90 d生存率比较,差异无统计学意义(P>0.05),CLIF-C ACLFs<48组受体术后90 d生存率为94%,明显高于CLIF-C ACLFs≥48组的79%(P<0.05)。结论 ACLF受体肝移植术后早期预后与其自身病情严重程度相关,而与选用供体的DRI无明显相关性,应早期及时行肝移植治疗。

Objective To evaluate the effect of donor risk index (DRI) on the early prognosis of liver transplantation for acute-on-chronic liver failure (ACLF). Methods Clinical data of 159 ACLF recipients undergoing liver transplantation were retrospectively analyzed. According to the calculation formula of DRI, all recipients were divided into DRI<1.65 group (n=96) and DRI≥1.65 group (n=63). Based on the Chronic Liver Failure Consortium acute-onchronic liver failure score (CLIF-C ACLFs), all recipients were divided into CLIF-C ACLFs<48 group (n=78) and CLIF-C ACLFs≥48 group (n=81). The early prognosis indexes including the length of intensive care unit (ICU) stay and the length of postoperative hospital stay of the recipients in each group were observed after liver transplantation. The 90 d survival rate of the recipients after liver transplantation was analyzed by Kaplan-Meier survival curve. The risk factors affecting the early prognosis of ACLF recipients after liver transplantation were analyzed by Cox's hazards regression model. Results The length of ICU stay and the length of postoperative hospital stay did not significantly differ between the DRI<1.65 group and DRI≥1.65 group (both P>0.05). The length of postoperative hospital stay did not significantly differ between the CLIF-C ACLFs<48 group and CLIF-C ACLFs≥48 group (P>0.05). The length of ICU stay in the CLIF-C ACLFs<48 group was 4 (3-14) d, significantly shorter than 7 (1-33) d in the CLIF-C ACLFs≥48 group (P<0.05). The CLIF-C ACLFs was a risk factor of the early prognosis of ACLF recipients after liver transplantation (P<0.05). The postoperative 90 d survival rate did not significantly differ between the DRI<1.65 group and DRI≥1.65 group (P>0.05). The postoperative 90 d survival rate in the CLIF-C ACLFs<48 group was 94%, significantly higher than 79% in the CLIF-C ACLFs≥48 group (P<0.05). Conclusions The early prognosis of ACLF recipients after liver transplantation is correlated with the severity of the disease rather than the DRI. Liver transplantation should be performed early and promptly.