肝移植术后原发性移植物无功能的临床特点和危险因素分析:单中心报道

Clinical features and outcomes of primary non-function after liver transplantation:A single-center report

目的探讨本中心公民器官捐献时代肝移植术后原发性移植物无功能(PNF)的临床特点及危险因素。方法回顾性分析2015年1月至2019年12月间中山大学附属第一医院647例实施成年肝移植患者的临床资料、实验室参数和随访结果。结果研究期间术后29例(4.48%)发生PNF,表现为肝脏合成功能和代谢功能障碍,丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)和总胆红素(TBIL)迅速升高和伴有严重的凝血功能障碍。单因素和多因素分析发现,术前肾脏替代治疗、手术总时长和供体风险指数(DRI)是PNF的独立危险因素,其中DRI预测PNF的最佳临界值为2.24(AUC=0.756,P=0.002)。结论PNF是肝移植术后少见的严重并发症,再次肝移植是唯一有效的治疗方法。术前肾脏替代治疗、手术总时长和DRI是肝移植术后发生PNF的独立危险因素,并且DRI>2.24可能是预测PNF的有效指标,可以作为供肝弃用及使用常温机械灌注技术的重要参考。

Objective To investigate the clinical characteristics and risk factors of primary non-function(PNF)after liver transplantation in the era of volunteer deceased organ donation in our center.Methods Clinical data,laboratory parameters and follow-up results of 647 adult liver transplantation patients in the First Affiliated Hospital of Sun Yat-sen University from January 2015 to December 2019 were retrospectively analyzed.Results During the study period,PNF occurred in 29 patients(4.48%)post-transplantation.The functional characteristics of PNF patients were liver synthesis and metabolic dysfunction,with alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TBIL)rapidly rising,accompanied by severe coagulation dysfunction.Univariate and multivariate analysis showed that preoperative kidney replacement therapy,total duration of operation and donor risk index(DRI)were independent risk factors for PNF,in which DRI>2.24 was the best critical point for predicting PNF(AUC=0.756,P=0.002).Conclusions PNF is a rare and serious complication after liver transplantation,and re-transplantation is the only effective treatment.It is found that preoperative kidney replacement therapy,total duration of operation and DRI are independent risk factors for PNF,and DRI>2.24 appears to be a potential predictor of PNF,which may help to discard a donor liver or attempt to use normothermic machine perfusion for organ preservation.