脂肪肝供体对良性肝病肝移植预后的影响

Influence of fatty liver donor in the prognosis of benign liver disease liver transplantation

目的探究脂肪肝供体对良性肝病肝移植预后的影响。方法回顾性分析2015年1月—2019年12月因良性肝脏疾病于首都医科大学附属北京朝阳医院行肝移植术的229例受者以及供体的临床资料。按照供肝脂肪变性程度,分为无脂肪肝组168例,轻-中度脂肪肝组43例,重度脂肪肝组18例,首先分析肝移植术后的总体预后情况,对比供体及受体一般资料,并对比三组病例的围手术期并发症。最后进行生存分析,对比三组的远期预后。计量资料符合正态分布采用均数±标准差(Mean±SD)表示,组间比较采用t检验。计数资料两组之间比较采用χ^(2)检验,有理论频数小于1,采用Fisher确切概率法,多组之间的比较采用方差分析。结果患者的总体1、3、5年生存率分别为86.9%、70.7%、70.7%,平均生存时间为53.1个月。三组之间供体、受体的一般资料没有明显区别,接受重度脂肪肝的受体围手术期发生移植肝无功能、肝功能恢复延迟、急性肾损伤的概率显著高于轻-中度脂肪肝组及非脂肪肝组(P<0.05)。生存分析结果表明:无脂肪肝组的1、3、5年生存率分别为90.5%、71.7%、71.7%,轻-中度脂肪肝组分别为88.4%、76.7%、64.0%,重度脂肪肝组分别为61.1%、49.4%和49.4%,重度脂肪肝患者的生存率显著低于其他两组患者(P<0.05)。结论供体重度脂肪变性导致患者移植肝无功能、肝功能恢复延迟、急性肾损伤的发生率更高,远期预后更差。

Objective To explore the influence of fatty liver donor on the prognosis of benign liver disease liver transplantation.Methods The clinical data of 229 recipients and donors who underwent liver transplantation at Beijing Chaoyang Hospital affiliated to Capital Medical University from January 2015 to December 2019 due to benign liver diseases were retrospectively analyzed.According to the degree of fatty degeneration of the donor liver,the patients were divided into non-fatty liver group(n=168),mild-medium fatty liver group(n=43),and severe fatty liver group(n=18).First,the overall prognosis after liver transplantation was analyzed,the general data of the donor and recipient were compared,and the perioperative complications of the three groups were compared.Finally,survival analysis was performed to compare the long-term prognosis of the three groups.Measurement data with the normal distribution were represented as(Mean±SD),comparisons among groups were analyzed using t test.Comparisons of counting data between groups were analyzed using chi-square test.The theoretical frequency was less than 1.Fisher exact probability method was used,and variance analysis was used for the comparison among the multiple groups.Results The overall 1-year,3-year,and 5-year survival rates of the patients were 86.9%,70.7%,70.7%,respectively,and the average survival time was 53.1 months.The general data of donors and recipients were not significantly different among the three groups.The probability of perioperative transplanted liver failure,delayed liver function recovery,and acute kidney injury in recipients with severe fatty liver was significantly higher than that of mild to moderate fatty liver group and non-fatty liver group(P<0.05).The results of survival analysis showed that the 1-year,3-year,and 5-year survival rates of the non-fatty liver group were 90.5%,71.7%,71.7%,the mild-moderate group were 88.4%,76.7%,64.0%and the severe fatty liver group were 61.1%,49.4%,49.4%,the survival rate of patients with severe fatty liver was significantly lower than that of the other two groups(P<0.05).Conclusion Donor weight-grade steatosis leads to a higher incidence of transplanted liver failure,delayed liver function recovery,acute kidney injury,and worse long-term prognosis.