Risk factors, surgical complications and graft survival in liver transplant recipients with early allograft dysfunction
Risk factors, surgical complications and graft survival in liver transplant recipients with early allograft dysfunction
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DOI：
10.1016/j.hbpd.2019.02.005
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发表时间：
2019-10-01
影响因子：
3.3
通讯作者：
de Almeida, Marcio Dias
中科院分区：
文献类型：
--
作者：
Bastos-Neves, Douglas;de Oliveira Salvalaggio, Paolo Rogerio;de Almeida, Marcio Dias
背景：早期移植物功能障碍（EAD）是肝移植术后的严重并发症。相关的风险因素和并发症最近重新引起了人们的兴趣。本研究探讨了危险因素，生存率和并发症与EAD在一个大型肝移植center in Latin America.Methods：回顾性，单中心，队列，从2009年1月至2013年12月接受首次死亡供体肝移植的成人患者的数据为基础。EAD的定义为以下一个或多个：（i）术后第7天胆红素≥ 10 mg/dL;（ii）术后第7天国际标准化比值≥ 1.6;（iii）移植后前7天内丙氨酸氨基转移酶或天冬氨酸氨基转移酶>2000 IU/L。供者危险因素为男性（P = 0.007）、年龄50 - 59岁（P = 0.034）、超重（P = 0.028）或I级肥胖（P = 0.012）、钠>157 mmol/L（P = 0.002）和IV级缺血/再灌注损伤（P = 0.002）。冷缺血时间>= 10 h（P = 0.008）和热缺血时间>= 40 min（P = 0.013）为手术因素。雄性（P 157 mmol/L）和IV级缺血/再灌注损伤。冷缺血时间>= 10 h、热缺血时间>= 40 min为手术危险因素。男性是唯一的受体保护因素。EAD患者的再手术率和移植物丢失率较高。(C)2019中国浙江大学医学院附属第一医院。Elsevier B. V.出版，保留所有权利。
Background: Early allograft dysfunction (EAD) is a severe complication after liver transplantation. The associated risk factors and complications have re-gained recent interest. This study investigated risk factors, survival and complications associated with EAD in a large liver transplant center in Latin America.Methods: Retrospective, unicenter, cohort, based on data from adult patients undergoing first deceased-donor liver transplant from January 2009 to December 2013. EAD was defined by one or more of the following: (i) bilirubin >= 10 mg/dL on postoperative day 7; (ii) international normalized ratio >= 1.6 on postoperative day 7, and (iii) alanine aminotransferase or aspartate aminotransferase >2000 IU/L within the first seven days after transplant.Results: A total of 602 patients were included; of these 34.2% developed EAD. Donor risk factors were male (P = 0.007), age between 50 and 59 years (P = 0.034), overweight (P = 0.028) or grade I obesity (P = 0.012), sodium >157 mmol/L (P = 0.002) and grade IV ischemia/reperfusion injury (P = 0.002). Cold ischemia time >= 10 h (P = 0.008) and warm ischemia time >= 40 min (P = 0.013) were the surgical factors. Male (P 157 mmol/L and grade IV ischemia/reperfusion injury. Cold ischemia time >= 10 h and warm ischemia time >= 40 min were the surgical risk factors. Male was the only recipient protective factor. Patients with EAD had higher reoperations and graft loss rates. (C) 2019 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.