成年肝移植术后死亡受者145例临床特征分析

CLINICAL FEATURES OF THE ADULT RECIPIENTS WHO DIED AFTER LIVER TRANSPLANTATION:AN ANALYSIS OF 145 CASES

目的探讨成年肝移植术后死亡受者的临床特征,为改善成年肝移植受者早中远期预后提供参考。方法回顾性分析2016年1月-2020年12月在我院器官移植中心接受手术的145例成年肝移植死亡受者的临床资料,包括受者原发病、终末期肝病模型评分、手术方式、供肝冷缺血时间、死亡原因及死亡时间等指标。结果145例成年肝移植死亡受者中术后0~30 d死亡23例,其中因感染并发症死亡7例(4.82%),心血管事件死亡5例(3.45%);术后31~90 d死亡16例,其中因感染并发症死亡8例(5.51%);术后>90 d死亡106例,因肝癌复发死亡88例(60.69%)。本研究中共98例肝细胞癌受者,中位生存时间492.0(279.0,727.0)d。符合米兰标准组、符合杭州超米兰标准组、符合超杭州标准组三组受者的生存时间总体比较差异有显著性(χ^(2)=8.861,P<0.05),其中符合超杭州标准组与符合米兰标准组、符合杭州超米兰标准组比较,受者中位生存时间均显著缩短(χ^(2)=17.246、16.912,P<0.05)。结论导致成年肝移植术后早中期死亡的主要原因为感染并发症,其次为心血管事件,术后晚期死亡的主要原因为肝癌复发。积极防治感染并发症、心血管事件及肝癌复发等并发症,将有助于提高成年肝移植术后受者的存活率。

Objective To investigate the clinical features of the adult recipients who died after liver transplantation(LT),and to provide a reference for improving the early-,middle-,and long-term prognosis of adult LT recipients.Methods A retrospective analysis was performed for the clinical data of 145 adult LT recipients who underwent surgery and died in Organ Transplantation Center of our hospital from January 2016 to December 2020,including primary diseases,MELD score,surgical procedure,cold ischemia time of donor liver,cause of death,and death time.Results Among the 145 dead adult LT recipients,23 died within 0-30 d after surgery,among whom 7(4.82%)died of infectious complication and 5(3.45%)died of cardiovascular events;16 patients died within 31-90 d after surgery,among whom 8(5.51%)died of infectious complication;106 patients died at more than 90 d after surgery,among whom 88(60.69%)died of liver cancer recurrence.There were 98 recipients with hepatocellular carcinoma in this study,and the median survival time was 492.0(279.0,727.0)d.There was a significant difference in survival time between the group meeting Milan criteria,the group meeting Hangzhou criteria,and the group meeting super-Hangzhou criteria(χ^(2)=8.861,P<0.05),and the group meeting super-Hangzhou criteria group had a significantly shorter median survival time than the group meeting Milan criteria and the group meeting Hangzhou criteria(χ^(2)=17.246,16.912,P<0.05).Conclusion Infectious complication is the main cause of death in the early and middle stages after LT in adult recipients,followed by cardiovascular events,while liver cancer recurrence is the main cause of death in the late stage after LT.Active prevention and treatment of infectious complication,cardiovascular events,and liver cancer recurrence may help to improve the survival rate of adult recipients after LT.