Risk factors of severe ischemic biliary complications after liver transplantation
Risk factors of severe ischemic biliary complications after liver transplantation
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DOI：
10.1016/s1499-3872(11)60063-5
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发表时间：
2011-08-01
影响因子：
3.3
通讯作者：
Fan, Hua
中科院分区：
文献类型：
--
作者：
Wang, Ming-Feng;Jin, Zhong-Kui;Fan, Hua
背景：原位肝移植后，缺血相关的胆道并发症仍然很高。严重的缺血性胆道并发症常累及肝管分叉处和左肝管，最终导致梗阻性黄疸。此类并发症的预防和处理对于移植外科医生来说仍然是一个挑战。方法：所有 160 名患者在移植后均进行了至少 180 天的随访。对3组（无并发症；轻度并发症；严重并发症）进行单因素方差分析（ANOVA）和比较单变量分析，分析与胆道并发症相关的危险因素。排除其他混杂因素后，采用多元logistic回归和线性回归分析严重缺血性胆道并发症的独立危险因素。结果：通过方差分析和单因素比较分析，胆道并发症的危险因素为术前胆红素水平（P=0.007）和吻合口T管支架置入术（P=0.016）。多元logistic回归分析显示T管使用情况和术前血清胆红素水平不是原位肝移植术后严重缺血性胆道并发症的独立危险因素。卡方分析表明，在严重缺血性胆道病变的发生中，胆管第二次热缺血时间长于60分钟是显着的危险因素。线性回归显示冷保存时间与热缺血时间呈负相关。结论：术前血清胆红素水平和吻合口T管支架的使用是肝移植术后胆道并发症的独立危险因素，但不是严重缺血性胆道并发症的独立危险因素。胆管二次热缺血时间超过60分钟、胆管二次热缺血时间延长联合冷保存时间是无心跳供体肝移植术后发生严重缺血性胆道并发症的重要危险因素。
BACKGROUND: Ischemia-related biliary tract complications remain high after orthotopic liver transplantation. Severe ischemic biliary complications often involve the hepatic duct bifurcation and left hepatic duct, resulting finally in obstructive jaundice. Prevention and management of such complications remain a challenge for transplant surgeons.METHODS: All 160 patients were followed up for at least 180 days after transplantation. One-way analysis of variance (ANOVA) and comparative univariate analysis were made using 3 groups (no complications; mild complications; severe complications), to analyze risk factors associated with biliary complications. Multiple logistic regression and linear regression analysis were used to analyze independent risk factors for severe ischemic biliary complications, after excluding other confounding factors.RESULTS: By ANOVA and comparative univariate analysis, the risk factors associated with biliary complications were preoperative bilirubin level (P=0.007) and T-tube stenting of the anastomosis (P=0.016). Multiple logistic regression analysis showed that the use of T-tube and preoperative serum bilirubin were not independent risk factors for severe ischemic biliary complications after orthotopic liver transplantation. Chi-square analysis indicated that in the incidence of severe ischemic biliary lesions, bile duct second warm ischemic time longer than 60 minutes was a significant risk factor. Linear regression demonstrated a negative correlation between cold preservation time and warm ischemia time.CONCLUSIONS: Preoperative serum bilirubin level and the use of T-tube stenting of the anastomosis were independent risk factors for biliary complications after liver transplantation, but not for severe ischemic biliary complications. The second warm ischemia time of bile duct longer than 60 minutes and prolonged bile duct second warm ischemia time combined with cold preservation time were significant risk factors for severe ischemic biliary complications after liver transplantation with grafts from non-heart-beating donors.