公民逝世后器官捐献高钠供肝肝移植对受者预后的影响分析

Influencing of high sodium donor liver transplantation from the death of a citizen′s organ donation on the prognosis of recipients

目的探讨公民逝世后器官捐献(DCD)高钠供肝肝移植对受者预后的影响。方法采用回顾性队列研究方法。收集2015年1月至2021年6月空军军医大学西京医院收治的125对行DCD肝移植供者及受者的临床病理资料;供者男93例,女32例;受者男92例,女33例;年龄为48(41,55)岁。125例受者根据供肝末次血清钠离子水平分组,9例供肝钠离子水平≥170 mmol/L设为第1组(极高钠),33例供肝钠离子水平≥150 mmol/L且<170 mmol/L设为第2组(中度高钠),83例供肝钠离子水平<150 mmol/L设为第3组(正常钠)。观察指标:(1)术后恢复情况。(2)随访情况和生存分析。正态分布的计量资料以x±s表示,重复测量资料采用重复测量方差分析;偏态分布的计量资料以M(Q1,Q3)表示,组间比较采用Kruskal-Wallis检验。计数资料以绝对数表示,采用Pearsonχ2检验或Fisher检验。采用Kaplan-Meier法绘制生存曲线,Log-rank检验进行生存分析。结果(1)术后恢复情况。第1组受者丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBil)、碱性磷酸酶(ALP)、凝血酶原时间(PT)、国际标准化比值(INR)、白蛋白(Alb)、肌酐(Cr)术后第1天至第14天变化情况分别为(736±972)IU/L~(75±46)IU/L、(1290±1651)IU/L~(38±20)IU/L、(102±98)μmol/L~(33±11)μmol/L、(66±34)IU/L~(104±54)IU/L、(19.9±3.3)s~(11.3±1.0)s、1.76±0.31~1.00±0.08、(34±5)g/L~(38±3)g/L、(91±41)μmol/L~(76±19)μmol/L,第2组受者上述指标变化情况分别为(505±377)IU/L~(48±46)IU/L、(855±727)IU/L~(24±17)IU/L、(64±42)μmol/L~(32±22)μmol/L、(68±51)IU/L~(91±46)IU/L、(16.8±3.5)s~(11.9±1.2)s、1.47±0.30~1.04±0.09、(33±4)g/L~(40±5)g/L、(106±32)μmol/L~(97±27)μmol/L,第3组受者上述指标变化情况分别为(637±525)IU/L~(65±60)IU/L、(929±1193)IU/L~(33±27)IU/L、(66±48)μmol/L~(33±36)μmol/L、(64±28)IU/L~(125±64)IU/L、(17.2±4.7)s~(13.3±12.8)s、1.51±0.42~1.05±0.13、(35±6)g/L~(39±4)g/L、(105±44)μmol/L~(94±40)μmol/L。整体效应结果显示:3组受者肝移植后TBil变化趋势(时间效应、组间效应、交互效应)比较,差异均有统计学意义(F_(组间)=5.42,F_(时间)=22.78,F_(交互)=3.85,P<0.05)。3组受者肝移植后ALT、AST、ALP、PT、INR、Alb、Cr时间效应比较,差异均有统计学意义(F_(时间)=50.17,36.24,19.24,10.55,59.61,41.94,10.82,P<0.05)。(2)随访情况和生存分析。125例受者均获得随访。第1组受者术后早期肝功能不全(EAD)、术后1年移植肝衰竭、术后1年胆道并发症、术后1年血管并发症、术后1年排斥反应分别为2、1、0、0、0例,第2组受者上述指标分别为2、1、3、0、1例,第3组受者上述指标分别为10、8、20、1、6例,3组受者上述指标比较,差异均无统计学意义(χ^(2)=1.58,0.60,5.19,1.62,0.97,P>0.05)。第1组受者移植肝1、3年累积存活率分别为100.00%、100.00%;第2组上述指标分别为94.74%、77.16%;第3组上述指标分别为91.57%、89.30%;3组受者移植肝累积存活率比较,差异均无统计学意义(χ^(2)=2.69,P>0.05)。第1组受者1、3年累积生存率分别为100.00%、100.00%,第2组上述指标分别为93.74%、77.16%,第3组上述指标分别为89.40%、86.00%,3组受者累积生存率比较,差异无统计学意义(χ^(2)=1.94,P>0.05)。结论高钠供肝可用于DCD肝移植。

Objective To investigate the influencing of high sodium donor liver transplan-tation from the death of a citizen′s organ donation(DCD)on the prognosis of recipients.Methods The retrospective cohort study was constructed.The clinicopathological data of 125 pairs of donors and recipients who underwent DCD liver transplantation in Xijing Hospital of Air Force Military Medical University from January 2015 to June 2021 were collected.Of the 125 donors,there were 93 males and 32 females.Of the 125 recipients,there were 92 males and 33 females,aged 48(41,55)years.According to the last time of serum sodium level of donor liver in the 125 recipients,9 donor livers with serum sodium level≥170 mmol/L were divided into group 1(extremely high sodium),33 donor livers with serum sodium level≥150 mmol/L and<170 mmol/L were divided into group 2(moderate high sodium),and 83 donor livers with serum sodium level<150 mmol/L were divided into group 3(normal sodium),respectively.Observation indicators:(1)postoperative recover situations;(2)follow-up and survival analysis.Measurement data with normal distribution were represented as Mean±SD.Repeated measures were analyzed by repeated measures ANOVA.Measurement data with skewed distribution were represented as M(Q1,Q3),and comparison between groups was analyzed using the Kruskal-Wallis test.Count data were described as absolute numbers,and Pearson chi-square test or Fisher exact probability were used for data test.The Kaplan-Meier method was used to draw survival curves and Log-rank test was used for survival analysis.Results(1)Postoperative recover situations.The changes of alanine transaminase(AlT),aspartate aminotransferases(AST),total bilirubin(TBil),alkaline phosphatase(ALP),prothrombin time(PT),international normalized ratio(INR),albumin(Alb)and creatinine(Cr)from the first day to the 14th day after operation were(736±972)IU/L to(75±46)IU/L,(1290±1651)IU/L to(38±20)IU/L,(102±98)μmol/L to(33±11)μmol/L,(66±34)IU/L to(104±54)IU/L,(19.9±3.3)seconds to(11.3±1.0)seconds,1.76±0.31 to 1.00±0.08,(34±5)g/L to(38±3)g/L and(91±41)μmol/L to(76±19)μmol/L,respectively,in the recipients of group 1.The above indicators were(505±377)IU/L to(48±46)IU/L,(855±727)IU/L to(24±17)IU/L,(64±42)μmol/L to(32±22)μmol/L,(68±51)IU/L to(91±46)IU/L,(16.8±3.5)seconds to(11.9±1.2)seconds,1.47±0.30 to 1.04±0.09,(33±4 g/L)to(40±5)g/L and(106±32)μmol/L to(97±27)μmol/L in the recipients of group 2 and(637±525)IU/L to(65±60)IU/L,(929±1193)IU/L to(33±27)IU/L,(66±48)μmol/L to(33±36)μmol/L,(64±28)IU/L to(125±64)IU/L,(17.2±4.7)seconds to(13.3±12.8)seconds,1.51±0.42 to 1.05±0.13,(35±6)g/L to(39±4)g/L,(105±44)μmol/L to(94±40)μmol/L in the recipients of groups.Results of overall effect showed there were significant differ-ences in the change trend of TBil(time effect,inter-group effect,interaction effect)in recipients among the three groups after liver transplantation(F_(group)=5.42,F_(time)=22.78,F_(interaction)=3.85,P<0.05).There were significant differences in the time effect of ALT,AST,ALP,PT,INR,Alb,Cr in recipients among the three groups after liver transplantation(F_(time)=50.17,36.24,19.24,10.55,59.61,41.94,10.82,P<0.05).(2)Follow-up and survival analysis.All recipients were followed up.Cases with early postoperative liver dysfunction,cases with donor liver failure 1 year after operation,cases with biliary complica-tions 1 year after operation,cases with vascular complications 1 year after operation,cases with rejection 1 year after operation were 2,1,0,0,0 in the recipients of group 1.The above indicators were 2,1,3,0,1 in the recipients of group 2 and 10,8,20,1,6 in the recipients of group 3.There was no significant difference in the above indicators among the three groups(χ^(2)=1.58,0.60,5.19,1.62,0.97,P>0.05).The 1-year and 3-year cumulative survival rates of the donor liver were 100.00%and 100.00%in the recipients of group 1 after liver transplantation.The above indicators were 94.74%and 77.16%in the recipients of group 2 and 91.57%and 89.30%in the recipients of group 3.There was no significant difference in the cumulative survival rate of donor liver among the three groups(χ^(2)=2.69,P>0.05).The 1-year and 3-year cumulative survival rates were 100.00%and 100.00%in the recipients of group 1 after liver transplantation.The above indicators were 93.74%and 77.16%in the recipients of group 2 and 89.40%and 86.00%in the recipients of group 3.There was no significant difference in the cumulative survival rate among the three groups(χ^(2)=1.94,P>0.05).Conclusion Donor livers with high serum sodium level can be used in the DCD liver transplantation.