原位肝移植术后胆道狭窄的危险因素及预后分析

Risk factors for biliary stricture and prognosis after orthotopic liver transplantation

目的探讨原位肝移植术后2年内发生胆道狭窄的危险因素并进行生存分析。方法回顾性分析吉林大学第一医院肝移植中心2014年1月—2022年1月495例实施的肝移植手术患者的资料。根据肝移植术后两年内是否发生胆道狭窄,将495例患者分为胆道狭窄组(n=89)和非胆道狭窄组(n=406),进行胆道狭窄的危险因素和预后分析。正态分布的计量资料两组间比较采用成组t检验;偏态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ2检验。应用Cox单因素和多因素回归分析进行危险因素分析。应用Kaplan-Meier法进行生存分析。结果受体性别(HR=1.808,95%CI:1.055~3.098,P=0.031)、受体术前总胆红素(HR=1.002,95%CI:1.001~1.003,P=0.001)、冷缺血时间(HR=1.003,95%CI:1.001~1.005,P=0.007)、受体既往腹部手术史(HR=3.851,95%CI:2.273~6.524,P<0.001)和供体受体胆管不匹配(HR=1.962,95%CI:1.041~3.698,P=0.037)是移植术后2年内发生胆道狭窄的独立危险因素。通过中位随访期为4.09年的随访,肝移植术后患者的1、3和5年生存率分别为92.7%、80.5%和75.4%。肝移植术后2年内发生的胆道狭窄对原位肝移植患者的生存影响无统计学意义。结论受体性别、受体术前总胆红素、冷缺血时间、受体既往腹部手术史和供体受体胆管不匹配是移植术后2年内发生胆道狭窄的独立危险因素。肝移植术后2年内发生的胆道狭窄并不影响肝移植患者的生存期。

Objective To investigate the risk factors for biliary stricture within two years after orthotopic liver transplantation,and analyze the survival.Methods A retrospective analysis was performed for the data of 495 patients who underwent liver transplantation at Liver Transplantation Center of The First Hospital of Jilin University from January 2014 to January 2022,and according to the presence or absence of biliary stricture within two years after liver transplantation,the 495 patients were divided into stricture group with 89 patients and non-stricture group with 406 patients.The risk factors for biliary stricture and prognosis were analyzed.The independent-samples t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.Univariate and multivariate Cox regression analyses were used for the analysis of risk factors,and the Kaplan-Meier method was used for survival analysis.Results Recipient sex(hazard ratio[HR]=1.808,95%confidence interval[CI]:1.055—3.098,P=0.031),preoperative total bilirubin of the recipient(HR=1.002,95%CI:1.001—1.003,P=0.001),cold ischemia time(HR=1.003,95%CI:1.001—1.005,P=0.007),history of abdominal surgery for the recipient(HR=3.851,95%CI:2.273—6.524,P<0.001),and mismatch of donor-recipient bile ducts(HR=1.962,95%CI:1.041—3.698,P=0.037)were identified as independent risk factors for biliary stricture within two years after transplantation.The median follow-up time was 4.09 years,and the 1-,3-,and 5-year survival rates were 92.7%,80.5%,and 75.4%,respectively,after liver transplantation.The onset of biliary stricture within two years after liver transplantation had no significant impact on the survival of patients undergoing orthotopic liver transplantation.Conclusion Recipient sex,preoperative total bilirubin of the recipient,cold ischemia time,history of abdominal surgery for the recipient,and mismatch of donor-recipient bile ducts are independent risk factors for biliary stricture within two years after transplantation.The onset of biliary stricture within two years after transplantation does not affect the survival time of patients undergoing orthotopic liver transplantation.