CAJ | 학술논문

目的分析中国二类心脏死亡器官捐献(DCD)供肝移植术后早期肝功能不全(EAD)的发生情况及相关危险因素.方法回顾性分析2011年7月至2014年7月间实施的42例DCD供肝移植供、受者的临床资料.所有42例DCD供者均为中国二类.对供者相关变量40个、手术相关变量4个及受者相关变量9个等因素进行单因素分析,并采用多因素分析找到术后早期发生EAD的危险因素.结果 42例受者中,术后诊断EAD 20例,发生率为47.6％(20/42).术后发生原发性移植物无功能4例,发生率为9.5％,且均满足EAD的诊断标准.EAD组术后6个月、12个月、18个月及24个月的受者累积存活率分别为81％、73％、73％、73％,非EAD组分别为94％、94％、84％、84％,组间差异均有统计学意义(P=0.037).经多因素分析发现,供者丙氨酸转氨酶(ALT)＞80 U/L是肝移植术后早期发生EAD的独立危险因素.当供者ALT＞80 U/L时,其诊断EAD的特异度及灵敏度分别为0.955和0.550,曲线下面积为0.720.结论供者ALT＞80 U/L是影响肝移植术后早期发生EAD的独立危险因素.积极的供者维护,严格的供者选择可改善DCD肝移植的预后.
목적 분석중국이류심장사망기관연헌(DCD)공간이식술후조기간공능불전(EAD)적발생정황급상관위험인소.방법 회고성분석2011년7월지2014년7월간실시적42례DCD공간이식공、수자적림상자료.소유42례DCD공자균위중국이류.대공자상관변량40개、수술상관변량4개급수자상관변량9개등인소진행단인소분석,병채용다인소분석조도술후조기발생EAD적위험인소.결과 42례수자중,술후진단EAD 20례,발생솔위47.6％(20/42).술후발생원발성이식물무공능4례,발생솔위9.5％,차균만족EAD적진단표준.EAD조술후6개월、12개월、18개월급24개월적수자루적존활솔분별위81％、73％、73％、73％,비EAD조분별위94％、94％、84％、84％,조간차이균유통계학의의(P=0.037).경다인소분석발현,공자병안산전안매(ALT)＞80 U/L시간이식술후조기발생EAD적독립위험인소.당공자ALT＞80 U/L시,기진단EAD적특이도급령민도분별위0.955화0.550,곡선하면적위0.720.결론 공자ALT＞80 U/L시영향간이식술후조기발생EAD적독립위험인소.적겁적공자유호,엄격적공자선택가개선DCD간이식적예후.
Objective To analyze the occurrence of early allograft dysfunction (EAD) after liver transplantation from 42 cases of Chinese type Ⅱ donation after cardiac death (DCD) and to reveal risk factors affecting their short-term prognosis.Method We retrospectively analyzed 42 cases of DCD liver transplantation from July 201l to July 2014 and all were Chinese type Ⅱ donation.After univariate analysis of selected 40 related variables from donors,4 surgery-related variables and 9 variables from recipients,we struggled to find the risk factors of EAD after liver transplantation by multivariate analysis.Result Twenty cases were diagnosed as having EAD after liver transplantation among 42 cases with the occurrence rate being 47.6％ (20/42).Four (9.5％) cases of primary non function (PNF) were detected and all fully complied with the EAD criteria.The recipients and graft cumulative survival rate in EAD group after 6-month,12-month,18-month and 24-month was 81 ％,73％,73％ and 73％,and that in non-EAD group was 94％,94％,84％ and 84％,respectively (P =0.037).Multivariate analysis revealed that donor serum alanine arninotransferase (ALT)＞80 U/L was independent risk factors for occurrence of EAD after liver transplantation.The specificity and sensitivity was 0.955 and 0.550 in the diagnosis of EAD by ALT＞80 U/L,respectively.The area under the curve was 0.720.Conclusion Donor serum ALT＞80 U/L was independent risk factors for occurrence of EAD after liver transplantation.Active donor maintenance and careful donor selection may improve the prognosis of DCD liver transplantation.