Hepatic flow is an intraoperative predictor of early allograft dysfunction in whole-graft deceased donor liver transplantation: An observational cohort study
Hepatic flow is an intraoperative predictor of early allograft dysfunction in whole-graft deceased donor liver transplantation: An observational cohort study
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DOI：
10.4254/wjh.v11.i9.689
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发表时间：
2019-09-27
影响因子：
2.4
通讯作者：
Angel Lopez-Baena, Jose
中科院分区：
文献类型：
--
作者：
Lozano Lominchar, Pablo;Igone Orue-Echebarria, Maitane;Angel Lopez-Baena, Jose
背景：肝移植术后早期同种异体移植物功能障碍(EAD)是导致发病率和死亡率的重要原因。为了确保足够的移植物功能，除了适当的血液供应外，还需要一个临界的肝细胞肿块。我们假设，术中测量门静脉和肝动脉血流可作为诊断EAD的预测指标。目的研究肝血流是否是LT术后EAD的独立预测因素。方法：本研究是一项单一机构的观察性队列研究。术中肝动脉血流量和门静脉血流量采用过渡血流法测定。EAD的定义使用Olthoff标准。采用单变量和多变量分析来确定EAD的术中预测因素。生存分析和预后因素分析采用Kaplan-Meier和Cox回归模型。结果2008年1月至2014年12月共进行了188例患者的195例肝移植手术。54例(27.7%)患者发生EAD。中位随访期为39mo。在单因素和多因素分析中，门静脉血流、肝动脉血流(HAF)和总肝动脉血流与EAD相关。HAF是30d患者死亡率的独立预后因素。结论术中对再灌注后血流量的测量似乎是EAD的预测因子；此外，HAF应被认为是30d患者死亡率的预测因子。
BACKGROUNDEarly allograft dysfunction (EAD) after liver transplantation (LT) is an important cause of morbidity and mortality. To ensure adequate graft function, a critical hepatocellular mass is required in addition to an appropriate blood supply. We hypothesized that intraoperative measurement of portal venous and hepatic arterial flow may serve as a predictor in the diagnosis of EAD.AIMTo study whether hepatic flow is an independent predictor of EAD following LT.METHODSThis is an observational cohort study in a single institution. Hepatic arterial blood flow and portal venous blood flow were measured intraoperatively by transit flow. EAD was defined using the Olthoff criteria. Univariate and multivariate analyses were used to determine the intraoperative predictors of EAD. Survival analysis and prognostic factor analysis were performed using the Kaplan-Meier and Cox regression models.RESULTSA total of 195 liver transplant procedures were performed between January 2008 and December 2014 in 188 patients. A total of 54 (27.7%) patients developed EAD. The median follow-up was 39 mo. Portal venous flow, hepatic arterial flow (HAF) and total hepatic arterial flow were associated with EAD in both the univariate and multivariate analyses. HAF is an independent prognostic factor for 30-d patient mortality.CONCLUSIONIntraoperative measurement of blood flow after reperfusion appears to be a predictor of EAD; Moreover, HAF should be considered a predictor of 30-d patient mortality.