Contribution of Donor Factors to Post-Reperfusion Severe Hyperglycemia in Patients Undergoing Living Donor Liver Transplantation
Contribution of Donor Factors to Post-Reperfusion Severe Hyperglycemia in Patients Undergoing Living Donor Liver Transplantation
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DOI：
10.12659/aot.893648
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发表时间：
2015-06-03
影响因子：
1.1
通讯作者：
Park, Chul Soo
中科院分区：
文献类型：
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作者：
Chung, Hyun Sik;Kim, Eun Sung;Park, Chul Soo
背景：活体肝移植（LDLT）期间移植物再灌注后血糖水平突然升高，但对导致这种现象的围手术期因素的研究很少。我们根据供者相关因素开发了再灌注后严重高血糖 (PRSH) 的预测模型。材料/方法：回顾了 279 例 LDLT 病例的术前和术中受者数据以及供者数据。计算每个 LDLT 手术阶段的平均血糖水平，并使用新肝阶段平均血糖水平 230 mg/dL 的临界值将患者分为 PRSH 组和非 PRSH 组。比较两组围手术期变量，并对选定变量进行多变量logistic回归，建立PRSH的预测模型。结果：有128例患者（45.9%）发生PRSH，其与术前糖尿病相关，但与终末期肝病模型或Child-Pugh-Turcotte评分无关。术中，PRSH 组比非 PRSH 组需要更多的输血，并且出现更多的循环功能不全。 PRSH 患者接受的移植物具有较高水平的脂肪变化和较大的移植物与受者比 (GRWR)（均 p= 10% (OR 3.53)、再灌注后综合征持续时间 >= 5 分钟 (OR 5.68) 和受者糖尿病 (OR 2.92) 作为独立危险因素。PRSH 的风险与 GRWR 的上升成正比。结论：PRSH 的发展很大程度上受到供者相关因素的影响移植物大小、脂肪变化程度和再灌注后综合征被确定为 PRSH 的独立供体相关预测因子。
Background: Blood glucose levels increase abruptly after graft reperfusion during living donor liver transplantation (LDLT), but studies on perioperative factors contributing to this phenomenon are rare. We developed a predictive model for post-reperfusion severe hyperglycemia (PRSH) based on donor-related factors.Material/Methods: Preoperative and intraoperative recipient data, as well as donor data, on 279 LDLT cases were reviewed. The mean blood glucose levels at each LDLT surgical phase were calculated, and patients were divided into PRSH and non-PRSH groups using a cutoff of 230 mg/dL mean blood glucose level during the neo-hepatic phase. Perioperative variables were compared between the 2 groups, and selected variables were subjected to multivariate logistic regression to establish a predictive model for PRSH.Results: There were 128 patients (45.9%) who developed PRSH, which was associated with preoperative diabetes mellitus but not with model for end-stage liver disease or Child-Pugh-Turcotte score. Intraoperatively, the PRSH group required more blood transfusions and experienced more circulatory insufficiency than did the nonPRSH group. PRSH patients received grafts with higher-level fatty changes and greater graft-to-recipient ratios (GRWRs) (both p= 10% (OR 3.53), post-reperfusion syndrome >= 5 min in duration (OR 5.68), and recipient diabetes mellitus (OR 2.92) as independent risk factors. The risk of PRSH was proportional to the rise in GRWR.Conclusions: PRSH development was heavily influenced by donor-related factors. Graft size, extent of fatty change, and postreperfusion syndrome were identified as independent donor-associated predictors of PRSH.