胆道闭锁患儿活体肝移植术中再灌注综合征的危险因素

Risk factors for postreperfusion syndrome during living donor liver transplantation in pediatric patients with biliary atresia

目的筛选胆道闭锁患儿活体肝移植术中再灌注综合征(PRS)的危险因素。方法回顾性收集2020年1月至2021年12月本中心行活体肝移植术的胆道闭锁患儿病历资料:(1)患儿一般情况:年龄、性别、身高、体质量;(2)术前资料:左心室射血分数、儿童终末期肝病评分、血清ALT、AST、TBIL、INR、Cr浓度和全血Hb浓度;(3)术中资料:再灌注前即刻生命体征和血气分析指标、无肝期时间、供肝冷缺血时间、移植肝质量、手术时间、麻醉时间、尿量、出血量、输血量及新鲜冰冻血浆输注量。根据术中是否发生PRS将患儿分为PRS组和非PRS组。采用二元logistic回归分析筛选危险因素。结果共纳入患儿304例,PRS组132例,非PRS组172例。PRS发生率为43.4%。logistic回归分析显示,移植肝冷缺血时间延长(OR=1.031,95%CI 1.021~1.041,P<0.001)和再灌注前即刻体温<36℃(OR=3.095,95%CI 1.656~5.785,P<0.001)是发生PRS的危险因素。结论再灌注前即刻体温<36.0℃和移植肝冷缺血时间延长是胆道闭锁患儿活体肝移植术中发生PRS的危险因素。

Objective To identify the risk factors for postreperfusion syndrome(PRS)during living donor liver transplantation in pediatric patients with biliary atresia.Methods The clinical data from pediatric patients who underwent living donor liver transplantation from January 2020 to December 2021 in our hospital were retrospectively analyzed.The clinical data included:(1)general information of the pediatric patients such as age,gender,height and body weight;(2)preoperative data such as left ventricular ejection fraction,pediatric end-stage liver disease score,serum aminotransferase,aspartate aminotransferase,total bilirubin,International Normalised Ratio and creatinine concentrations,and whole blood Hb concentration;(3)intraoperative data such as vital signs and blood gas analysis parameters immediate before reperfusion,time of anhepatic phase,donor liver cold ischemia time,transplanted liver quality,time of surgery,anesthesia time,volume of urine,blood loss,amount of blood transfused,and amount of fresh frozen plasma transfused.The pediatric patients were divided into PRS group and non-PRS group according to whether intraoperative PRS occurred.Risk factors for PRS were analyzed using binary logistic regression analysis.Results A total of 304 pediatric patients were finally enrolled,with 132 cases in PRS group and 172 cases in non-PRS group.The incidence of PRS was 43.4%.The results of logistic regression analysis showed that prolonged liver graft cold ischemic time(OR=1.031,95%confidence interval 1.021-1.042,P<0.001)and body temperature<36℃immediately before reperfusion(OR=3.095,95%confidence interval 1.656-5.785,P<0.001)were risk factors for PRS.Conclusions Body temperature immediately before reperfusion<36.0℃and prolonged liver graft cold ischemic time are risk factors for PRS during living donor liver transplantation in pediatric patients with biliary atresia.