公民逝世后器官捐献供肝微生物学培养阳性对肝移植术后恢复及预后的影响

Effect of microbiological culture-positive liver graft from donation after citizen’s death donor on recovery and prognosis after liver transplantation

目的探讨微生物学培养阳性的供肝对于肝移植受者术后恢复及预后的影响。方法采用回顾性对照研究方法,筛选复旦大学附属华山医院器官移植2016年7月—2017年3月的成人公民身后器官捐献有供肝微生物学检测资料的肝移植受者91例,分析供肝组织和保存液微生物学培养结果,根据是否培养阳性分为阳性和阴性两组。阳性受者根据标本不同分为肝组织阳性组,保存液阳性组及肝组织保存液双阳性组,分析供体微生物学检测阳性结果是否与肝移植术后感染的病原体一致,并比较不同组受者的移植后住院时间及围术期病死率。结果91例供体及器官保存液共有26例培养结果阳性。17例供体及器官保存液培养结果均为阳性,4例仅肝组织培养阳性,5例仅保存液培养阳性;有7例细菌及真菌培养同时阳性,仅细菌培养阳性13例,仅真菌培养阳性6例。20例细菌培养结果中,革兰阴性菌为11例(55%),革兰阳性菌为9例(45%),未检测出革兰阴性菌和阳性菌同时定植。细菌定植中占比前3位的分别是鲍曼不动杆菌、肺炎克雷伯菌和粪肠球菌。真菌定植中占比前3位的分别是白色念珠菌、热带念珠菌和曲霉菌。肝移植受者围术期死亡8例,其中5例为供体微生物检测阳性。阳性组受者有6例在移植术后确诊发生感染,发病率为23.1%,其中2例死亡,病死率为33%。阳性组7例真菌及细菌同时阳性的受者术后有4例死亡,病死率为57%,因感染死亡1例,因肝功能恢复不良导致多器官功能衰竭死亡3例。移植后住院时间,阳性组为(27±16)d,阴性组为(17±7)d,P<0.05;围术期病死率,阳性组为19.2%(5/26),阴性组为4.6%(3/65),P<0.05。结论供肝及其保存液有细菌或真菌定植与肝移植术后感染未必直接相关,但是与供体来源感染,移植术后供肝恢复延迟,移植术后住院时间延长有明显相关性。合并真菌和细菌定植的供肝肝移植术后病死率明显升高。

Objective To investigate the effect of microbiological culture-positive donor liver on recovery and prognosis after liver transplantation.Methods Ninety-one liver transplant recipients receiving organ donation from adult citizens with microbiological examination data of donor liver after death were screened out from our center between July 2016 and March 2017 using a retrospective case-control study.Microbiological culture results of donor liver tissues and preservation solution were analyzed.According to culture results,recipients were divided into positive group and negative group.Based on different specimens,the positive recipients were divided into liver tissue-positive group,preservation solution-positive group and liver tissue-and preservation solution-positive group.The presence of the same infected pathogens after liver transplantation was analyzed.Hospital stay and perioperative mortality after transplantation were compared among different groups.Results In the 91 cases of donors and organ preservation solutions,there were a total of 26 cases showed positive culture results.Among them,17 cases showed positive culture results in both donors and organ preservation solutions,4 cases presented positive culture results in only liver tissues and 5 cases demonstrated positive culture results in only preservation solutions;7 cases showed positive in both bacterial and fungal culture,13 cases presented positive in only bacterial culture and 6 cases demonstrated positive in only fungal culture.Among 20 cases of positive bacterial culture,gram-negative bacteria was found in 11(55%)cases and gram-positive bacteria in 9(45%)cases.Gram-negative bacteria and gram-positive bacteria were not detected at the same time.As for bacterial colonization,the top three were baumanii,klebsiella pneumonia and enterococcus faecalis,respectively.As for fungal colonization,the top three were Candida albicans,Candida tropicalis and Aspergillus,respectively.Among the recipients with liver transplantation,8 recipients showed perioperative death,5 were positive with microbiological examination.In the positive group,infection was confirmed in 6 cases after transplantation,presenting an incidence of 23.1%,and death occurred in 2 cases,with a mortality of 33%.In the positive group,there were 7 recipients with both fungi-and bacteria-positive,among which 4 recipients died after transplantation(mortality:57%),including 1 recipient who died from infection and 3 recipients who died from multiple organ failure caused by poor recovery of liver function.Hospital stay after transplantation was(27±16)d in the positive group and(17±7)d in the negative group(P<0.05).Perioperative mortality rate was 19.2%(5/26)and 4.6%(3/65)in the positive group and the negative group,respectively(P<0.05).Conclusion Bacterial or fungal colonization in donor livers and their preservation solutions is not directly related to infection after liver transplantation,but it is significantly correlated with donor-derived infection,delayed recovery of donor liver after transplantation,and prolonged hospital stay after transplantation.Donor livers with fungal colonization combined with bacterial colonization show significantly increased mortality rate after liver transplantation.