供者来源性感染对肝移植受者临床预后的影响

Effect of donor-derived infection on clinical prognosis of liver transplantation recipients

目的探讨供者来源性感染(donor-derived infection,DDI)对肝移植受者临床预后的影响。方法回顾性分析2019年6月~2021年9月安徽医科大学第一附属医院的75例公民逝世后器官捐献的肝脏移植患者的临床资料。根据供肝灌洗液培养结果,将受者分为阳性组(16例)和阴性组(59例),分析供肝灌洗液培养阳性病原体的分布,观察两组受者术后感染及相关并发症情况。根据是否发生DDI,分为DDI组(9例)和非DDI组(66例),比较两组受者围手术期及预后情况。结果75例供肝灌洗液中16例培养结果阳性,共分离出病原体20种,其中革兰阳性球菌占20%(4/20),革兰阴性杆菌占70%(14/20),真菌占10%(2/20)。75例受者中术后35例发生感染,最常见的感染部位为腹腔感染,其次为肺部感染,其中阳性组有75%(12/16)的受者发生感染,阴性组有39.0%(23/59)的受者发生感染,差异有统计学意义(P=0.01)。阳性组受者术后急性肾损伤(AKI)、脓毒症、腹腔内出血的发生率均高于阴性组受者,差异有统计学意义(P<0.05)。75例受者中共有9例受者发生DDI,发生率为12%(9/75),病死率55.6%(5/9)。与非DDI组受者相比,DDI组受者术后AKI、脓毒症、腹腔内出血原发性移植物无功能以及需要连续性肾脏替代治疗的发生率更高,机械通气时间、重症监护病房住院时间更长,围术期病死率更高,差异均有统计学意义(均为P<0.05)。结论DDI对肝移植受者临床预后有一定影响。

Objective To investigate the effect of donor-derived infection(donor-derived infection,DDI)on the clinical prognosis of liver transplant recipients.Methods The clinical data of 75 patients with liver transplantation donated after the death of citizens in the first affiliated Hospital of Anhui Medical University from June 2019 to September 2021 were analyzed retrospectively.According to the results of donor liver lavage fluid culture,the recipients were divided into positive group(n=16)and negative group(n=59).The distribution of positive pathogens in donor liver lavage fluid culture was analyzed,and the postoperative infection and related complications of the two groups were observed.According to the occurrence of DDI,the patients were divided into DDI group(n=9)and non-DDI group(re=66).The perioperative period and prognosis of the two groups were compared.Results Among the 75 donor liver lavage fluids,16 were positive and 20 pathogens were isolated,of which gram-positive cocci accounted for 20%(4/20),gram-negative bacilli accounted for 70%(14/20),and fungi accounted for 10%(2/20).Postoperative infection occurred in 35 of the 75 recipients,the most common site of infection was abdominal infection,followed by pulmonary infection.75%of the recipients in the positive group were infected,and 39.0%in the negative group were infected.The difference was statistically significant(P=0.01).The incidences of acute renal injury(AKI),sepsis and intra-abdominal hemorrhage in the positive group were significantly higher than those in the negative group(P<0.05).A total of 9 of the 75 recipients developed DDI,with an incidence of 12%(9/75)and a fatality rate of 55.6%(5/9).Compared with the non-DDI group,the DDI group had a higher incidence of postoperative AKI,sepsis,intra-abdominal hemorrhage,primary non-function and continuous renal replacement therapy,longer mechanical ventilation time,longer intensive care unit stay and higher perioperative mortality.Conclusion DDI has a certain influence on the clinical prognosis of liver transplantation recipients.