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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2016, Vol. 10 ›› Issue (05) : 354 -358. doi: 10.3877/cma.j.issn.1674-0793.2016.05.008

所属专题： 文献；

论著

公民身后器官捐献肝移植术后早期细菌和真菌感染并发症的临床特点与危险因素分析
林健文1, 韩明1, 王小平1, 鞠卫强1, 赵强1, 陈茂根1, 巫林伟1, 陈颖华1, 王东平1, 马毅1, 胡安斌1, 朱晓峰1, 郭志勇1, 何晓顺1,†()   
  1. 1. 510080　广州，中山大学附属第一医院器官移植中心
  • 收稿日期:2016-03-17 出版日期:2016-10-01
  • 通信作者: 何晓顺
  • 基金资助:
    国家高技术研究发展计划（863计划）项目(2012AA021008); 公益性行业科研专项基金项目(201302009); 卫生部部属（管）医院临床学科重点项目(2010159); 广东省器官捐献与移植免疫重点实验室建设项目(2013A061401007)

Analysis of clinical features and risk factors of bacteria and fungal infectious complications in early postoperative liver transplant recipients using organ from donation after citizens death

Jianwen Lin1, Ming Han1, Xiaoping Wang1, Weiqiang Ju1, Qiang Zhao1, Maogen Chen1, Linwei Wu1, Yinghua Chen1, Dongping Wang1, Yi Ma1, Anbin Hu1, Xiaofeng Zhu1, Zhiyong Guo1, Xiaoshun He1,†()   

  1. 1. Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2016-03-17 Published:2016-10-01
  • Corresponding author: Xiaoshun He
  • About author:
    Corresponding author: He Xiaoshun, Email:
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引用本文：

林健文, 韩明, 王小平, 鞠卫强, 赵强, 陈茂根, 巫林伟, 陈颖华, 王东平, 马毅, 胡安斌, 朱晓峰, 郭志勇, 何晓顺. 公民身后器官捐献肝移植术后早期细菌和真菌感染并发症的临床特点与危险因素分析[J]. 中华普通外科学文献(电子版), 2016, 10(05): 354-358.

Jianwen Lin, Ming Han, Xiaoping Wang, Weiqiang Ju, Qiang Zhao, Maogen Chen, Linwei Wu, Yinghua Chen, Dongping Wang, Yi Ma, Anbin Hu, Xiaofeng Zhu, Zhiyong Guo, Xiaoshun He. Analysis of clinical features and risk factors of bacteria and fungal infectious complications in early postoperative liver transplant recipients using organ from donation after citizens death[J]. Chinese Archives of General Surgery(Electronic Edition), 2016, 10(05): 354-358.

目的

对比分析公民身后器官捐献与传统司法途径器官捐献肝移植术后早期受体细菌和真菌感染并发症的临床特点，探讨公民身后器官捐献肝移植受体术后感染的危险因素。

方法

回顾性研究2011年1月至2013年12月间本中心实施的公民身后器官捐献肝脏供、受体（研究组）和司法途径来源器官捐献的肝移植受体病例（对照组），比较两组受体术后细菌、真菌感染的临床特点和预后，分析术后受体感染的危险因素。

结果

共纳入公民身后器官捐献肝脏供体43例；研究组受体72例，对照组受体80例。研究组受体的细菌、真菌感染总发生率显著高于对照组（47.2% vs 31.2%）（χ2=4.071，P=0.044）。研究组受体术后1周内的细菌感染率高于对照组（64.5% vs 38.2%）（χ2=6.133，P=0.018）。供体捐献前感染和开放性创伤史是术后受体感染的独立危险因素（P=0.025、0.031）。4例疑似供体来源性受体感染，占研究组总感染例数的11.8%（4/34）。

结论

使用公民身后器官捐献来源器官的肝移植术后受体感染发生率显著高于传统司法途径来源，发生细菌感染的时间更早。供体器官捐献前存在感染和有开放性创伤是肝移植术后受体发生感染的危险因素。

关键词: 肝移植, 组织和器官获得, 组织供者, 公民身后器官捐献, 供体来源性感染
Objective

To compare the clinical characteristics of bacteria and fungal infectious complications after liver transplantation between using donation after citizen death and donation from executed prisoners and to find out the risk factors of infection after liver transplantation using donor after citizen death.

Methods

The clinical data of donor after citizen death and liver transplant recipients using donor after citizen death and donor from executed prisoners in our center from Jan 2011 to Dec 2013 were retrospectively analyzed. The clinical characteristics and prognosis of bacteria and fungal infectious complications after liver transplantation in both groups were compared to find out the risk factors of infection in liver transplantation using donor after citizen death.

Results

Forty-three donors after citizen death and 152 liver transplantation recipients were included in the study, including 72 recipients using donors after citizen death and 80 recipients using donors from executed prisoners. The bacteria and fungal infection rates were significantly higher in the recipients using donors after citizen death (47.2%) than recipients using donors from executed prisoners (31.2%) (χ2=4.071, P=0.044). Among the donors after citizen death whose recipients suffered infectious complications, the rates of infection before organ donation and open wound were 57.9% and 21.1%, which were significantly higher than donors whose recipients did not have infectious complications (P=0.025, 0.031, respectively). Moreover, 4 probable cases of donor-derived infection after liver transplantation were diagnosed, accounting for 11.8% of the infections in liver transplant recipients using donor after citizen death.

Conclusions

The bacteria and fungal infection rates are significantly higher in the liver transplant recipients using donors after citizen death than recipients using donors from executed prisoners. Using donors with infection or open wound before organ donation may increase the risk of bacteria and fungal infectious complications after liver transplantation.

Key words: Liver transplantation, Tissue and organ procurement, Tissue donors, Donation after citizen death, Donor-derived infection
表1 不同来源器官捐献肝移植术后受体感染及其预后的比较[例（%）]
项目 研究组(72例) 对照组(80例) χ2值 P值
总感染 34(47.2) 25(31.2) 4.071 0.044
? 细菌感染 21(29.2) 17(21.2) 1.267 0.260
? 真菌感染 4(5.6) 2(2.5) 0.933 0.334
? 混合感染 9(12.5) 6(7.5) 1.065 0.302
总感染事件数 78 46 ? ?
人均感染事件数 1.099 0.575 ? ?
感染所致死亡 2(2.8) 4(5.0) 0.494 0.482
术后感染时间(d)a ? ? ? ?
? 1~7 40(64.5) 13(38.2) 6.133 0.018
? >7~14 10(16.1) 11(32.4) 3.382 0.076
? >14~30 9(14.5) 6(17.6) 0.163 0.771
? >30~90 3(4.8) 4(11.8) 1.558 0.240
? 合计 62(100.0) 34(100.0) ? ?
表2 公民身后器官捐献肝移植术后受体感染组与无感染组的预后比较
项目 感染组(34例) 无感染组(38例) 统计值 P值
累积生存率(%) ? ? ? ?
? 3个月 82.4 84.2 0.045 0.833
? 12个月 79.4 81.5 0.054 0.817
术后中位住院天数a 37.5(2~98) 19.5(0~62) 3.653 0.011
术后非感染性并发症［例(%)］ ? ? ? ?
? 胆瘘 4(11.8) 0(0) 4.734 0.030
? 腹腔出血 4(11.8) 3(7.9) 0.306 0.580
? 消化道出血 1(2.9) 2(5.3) 0.242 0.623
? 肝动脉栓塞 2(5.9) 1(2.6) 0.475 0.491
? 下腔静脉狭窄 1(2.9) 0(0) 1.133 0.287
? 激素冲击治疗 3(8.8) 0(0) 3.499 0.061
图1 公民身后器官捐献肝移植术后受体Kaplan-Meier生存曲线
表3 公民身后器官捐献肝移植术后受体感染并发症的危险因素单因素分析（供体因素）[例（%）]
因素 受体感染组(19例) 受体无感染组(24例) 统计值 P值
性别（女） 1(5.3) 8(33.3) 5.049 0.055
年龄>45岁 5(26.3) 3(12.5) 1.337 0.432
个人史 ? ? ? ?
? 吸烟 6(31.6) 2(8.3) 3.784 0.111
? 吸毒 1(5.3) 0(0) 1.293 0.442
死亡原因 ? ? ? ?
? 脑外伤 10(52.6) 13(54.2) 0.010 1.000
? 脑血管病变 6(31.6) 7(29.2) 0.029 1.000
? 缺血缺氧性脑病 0(0) 3(12.5) 2.553 0.243
? 脑肿瘤 2(10.5) 0(0) 2.650 0.189
? 纵膈肿瘤 0(0) 1(4.2) 0.811 1.000
? 再障脑出血 1(5.3) 0(0) 1.293 0.442
有开放性创伤 4(21.1) 0(0) 5.571 0.031
手术史 13(68.4) 14(58.3) 0.462 0.542
ICU住院时间a 3(0.5~8) 3(0.5~27) -0.594 0.556
深静脉管留置时间a 6(1~90) 6(0.5~37) 0.227 0.822
气管导管留置时间a 6(3.5~31) 9(3~37) -1.229 0.226
尿管留置时间a 7(3.5~90) 9(0~37) 0.115 0.909
捐献前检验指标 ? ? ? ?
? 最高体温>38.5℃ 8(42.1) 7(29.2) 0.782 0.521
? 白细胞WBC>10或<4(×109/L) 16(84.2) 20(83.3) 0.006 1.000
? 血红蛋白Hb<90(g/L) 4(21.1) 11(45.8) 2.867 0.116
? 血清前白蛋白<100(mg/L) 7(36.8) 8(33.3) 0.057 1.000
器官切取场所 ? ? ? ?
? ICU 4(21.1) 3(12.5) 0.569 0.680
? 手术室 15(78.9) 21(87.5) 0.569 0.680
原发病收治医院等级 ? ? ? ?
? 三甲 5(26.3) 11(45.8) 1.729 0.221
? 二甲 14(73.7) 13(54.2) 1.729 0.221
捐献前感染 11(57.9) 5(20.8) 6.234 0.025
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