Risk factors of early allograft dysfunction in 49 cases of liver transplantation from donation after cardiac death

doi:10.3877/cma.j.issn.1674-0793.2015.02.008

Abstract

Abstract:

Objective

To summarize the occurrence of early allograft dysfunction (EAD) of 49 cases of liver transplantation from donation after citizen's death and to reveal risk factors affecting their short-term prognosis.

Methods

Forty-nine cases of liver transplantation from July 2011 to March 2013 in the First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. Forty-three related variables from donors, 6 surgery-related variables and 9 variables from recipients were selected for the occurrence of EAD.

Results

The occurrence rates of EAD after liver transplantation was 40.8%, among which 70.0% were diagnosed 7 days postoperatively by AST/ALT＞2 000 U/L. The recipients and graft cumulative survival rates of EAD group and non-EAD group after 1-, 6- and 12-month were 80.0%,75.0%, 75.0% and 93.1%, 93.1%, 78.8%, respectively. No statistically significant difference was observed(P=0.619). Through multivariate analysis, donor serum ALT＞200 U/L and serum chloride＞115 mmol/L were found as independent risk factors of EAD.

Conclusions

Donor serum ALT＞200 U/L and serum chloride＞115 mmol/L are independent risk factors of EAD. Careful donor maintenance and selection may improve the prognosis of liver transplantation from donation after citizen's death.

Key words: Donation after cardiac death, Liver transplantation, Prognosis, Early allograft dysfunction, Risk factor

Qiang Zhao, Wen Deng, Maogen Chen, Zhiyon Guo, Weiqiang Ju, Dongping Wang, Yi Ma, Xiaofeng Zhu, Xiaoshun He. Risk factors of early allograft dysfunction in 49 cases of liver transplantation from donation after cardiac death[J]. Chinese Archives of General Surgery(Electronic Edition), 2015, 09(02): 111-117.

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Figures/Tables 6

References 13

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变量	非EAD组(29例)	EAD组(20例)	χ ²值	P值
年龄(岁)			0.270	0.604
＞50	4(13.8)	1(5.0)
≤50	25(86.2)	19(95.0)
性别			0.000	1.000
男	24(82.8)	17(85.0)
女	5(17.2)	3(15.0)
血型			0.483	0.923
A	9(31.0)	6(30.0)
B	5(17.2)	5(25.0)
O	13(44.8)	8(40.0)
AB	2(6.9)	1(5.0)
体质指数(kg/m²)			0.229	0.633
＞25	5(17.2)	3(15.0)
≤25	14(82.8)	17(85.0)
吸烟史			2.814	0.093
有	20(69.0)	9(45.0)
无	9(31)	11(55.0)
饮酒史			0.000	1.000
有	4(13.8)	3(15.0)
无	25(86.2)	17(85.0)
手术史			0.552	0.458
有	10(34.5)	9(45.0)
无	19(65.5)	11(55.0)
细菌感染			1.963	0.161
有	1(3.4)	4(20.0)
无	28(96.6)	16(80.0)
真菌感染			0.194	0.659
有	2(6.9)	3(15.0)
无	27(93.1)	17(85.0)
热缺血时间(min)			0.000	1.000
＞20	4(13.8)	2(10.0)
≤20	25(86.2)	18(90.0)
冷缺血时间(min)			1.961	0.161
＞420	4(13.8)	7(35.0)
≤420	25(86.2)	13(65.0)
ICU住院时间(d)			9.462	0.002^a
＞7	4(13.8)	11(55.0)
≤7	25(86.2)	9(45.0)
死亡原因			0.907	0.635
脑出血	10(34.5)	7(35.0)
脑外伤	17(58.6)	10(50.0)
其他	2(6.9)	3(15.0)
血管活性药物使用			0.420	0.517
是	20(69.0)	12(60.0)
否	9(31)	8(40.0)
多巴胺使用(μg·kg^-1·min^-1)			0.000	1.000
＞15	2(6.9)	1(5.0)
≤15	27(93.1)	19(95.0)
去甲肾上腺素使用(μg·kg^-1·min^-1)
＞1.0	1(3.4)	4(20.0)	1.963	0.161
≤1.0	28(96.6)	16(80.0)

变量	非EAD组(29例)	EAD组(20例)	χ ²值	P值
年龄(岁)			0.270	0.604
＞50	4(13.8)	1(5.0)
≤50	25(86.2)	19(95.0)
性别			0.000	1.000
男	24(82.8)	17(85.0)
女	5(17.2)	3(15.0)
血型			0.483	0.923
A	9(31.0)	6(30.0)
B	5(17.2)	5(25.0)
O	13(44.8)	8(40.0)
AB	2(6.9)	1(5.0)
体质指数(kg/m²)			0.229	0.633
＞25	5(17.2)	3(15.0)
≤25	14(82.8)	17(85.0)
吸烟史			2.814	0.093
有	20(69.0)	9(45.0)
无	9(31)	11(55.0)
饮酒史			0.000	1.000
有	4(13.8)	3(15.0)
无	25(86.2)	17(85.0)
手术史			0.552	0.458
有	10(34.5)	9(45.0)
无	19(65.5)	11(55.0)
细菌感染			1.963	0.161
有	1(3.4)	4(20.0)
无	28(96.6)	16(80.0)
真菌感染			0.194	0.659
有	2(6.9)	3(15.0)
无	27(93.1)	17(85.0)
热缺血时间(min)			0.000	1.000
＞20	4(13.8)	2(10.0)
≤20	25(86.2)	18(90.0)
冷缺血时间(min)			1.961	0.161
＞420	4(13.8)	7(35.0)
≤420	25(86.2)	13(65.0)
ICU住院时间(d)			9.462	0.002^a
＞7	4(13.8)	11(55.0)
≤7	25(86.2)	9(45.0)
死亡原因			0.907	0.635
脑出血	10(34.5)	7(35.0)
脑外伤	17(58.6)	10(50.0)
其他	2(6.9)	3(15.0)
血管活性药物使用			0.420	0.517
是	20(69.0)	12(60.0)
否	9(31)	8(40.0)
多巴胺使用(μg·kg^-1·min^-1)			0.000	1.000
＞15	2(6.9)	1(5.0)
≤15	27(93.1)	19(95.0)
去甲肾上腺素使用(μg·kg^-1·min^-1)
＞1.0	1(3.4)	4(20.0)	1.963	0.161
≤1.0	28(96.6)	16(80.0)

变量	非EAD组(29例)	EAD组(20例)	χ ²值	P值
肝功能
尿素(mmol/L)			0.020	0.888
＞28	3(10.3)	1(5.0)
≤28	26(89.7)	19(95.0)
肌酐(μmol/L)			0.285	0.593
＞300	3(10.3)	4(20.0)
≤300	26(89.7)	16(80.0)
AST(U/L)			0.285	0.593
＞200	3(10.3)	4(20.0)
≤200	26(89.7)	16(80.0)
ALT(U/L)			4.819	0.028^a
＞200	1(3.4)	6(30.0)
≤200	28(96.6)	14(70.0)
谷氨酰转移酶(U/L)			1.880	0.170
＞120	3(10.3)	6(30.0)
≤120	26(89.7)	14(70.0)
碱性磷酸酶(U/L)			0.000	1.000
＞150	6(20.7)	4(20.0)
≤150	23(79.3)	16(80.0)
乳酸脱氢酶(U/L)			0.000	1.000
＞250	25(86.2)	17(85.0)
≤250	4(13.8)	3(15.0)
TB(μmol/L)			4.851	0.028^a
＞17.1	7(24.1)	11(55.0)
≤17.1	22(75.9)	9(45.0)
白蛋白(g/L)			1.090	0.296
＜30	13(44.8)	12(60.0)
≥30	16(55.2)	8(40.0)
生化
钠(mmol/L)			2.959	0.085
＞150	9(34.5)	12(60.0)
≤150	20(65.5)	8(40.0)
钾(mmol/L)			0.868	0.351
＞5.5	2(6.9)	4(20.0)
≤5.5	27(93.1)	16(80.0)
氯(mmol/L)			7.871	0.005^a
＞115	6(20.7)	12(60.0)
≤115	23(79.3)	8(40.0)
钙(mmol/L)			3.528	0.060
≤2.2	16(55.2)	17(85.0)
＞2.2	13(44.8)	3(15.0)
变量	非EAD组(29例)	EAD组(20例)	χ ²值	P值
血气分析
pH值
＜7.4	6(20.7)	4(20.0)	0.000	1.000
≥7.4	23(79.3)	16(80.0)
氧分压(mmHg)			1.271	0.260
＜80	23(79.3)	19(95.0)
≥80	6(20.7)	1(1.0)
二氧化碳分压(mmHg)			0.017	0.896
＞45	6(20.7)	3(15.0)
≤45	23(79.3)	17(85.0)
碳酸氢根(mmol/L)			0.000	1.000
＜22	6(20.7)	4(20.0)
≥22	23(79.3)	16(80.0)
碱剩余(mmol/L)			0.041	0.840
＜-3	8(27.6)	5(25.0)
≥-3	21(72.4)	15(75.0)
乳酸(mmol/L)			4.135	0.052
＞2.0	17(58.6)	5(25.0)
≤2.0	12(41.4)	15(75.0)
血常规
白细胞(×10⁹/L)			3.145	0.076
≤10	5(17.2)	8(40.0)
≥10	24(82.8)	12(60.0)
血红蛋白(g/L)			0.088	0.767
＜120	24(82.8)	18(90)
≥120	5(17.2)	2(10.0)
血小板(×10⁹/L)			0.993	0.319
＜100	9(31.3)	9(45.0)
≥100	20(68.7)	11(55.0)
中性粒细胞比例			0.034	0.854
＞80%	21(72.4)	14(70.0)
≤80%	8(27.6)	6(30.0)
红细胞(×10¹²/L)			0.356	0.551
＜3.0	12(41.3)	10(50.0)
≥3.0	17(58.7)	10(50.0)
出凝血常规
凝血酶原时间(s)			3.494	0.062
＞14	7(24.1)	10(50.0)
≤14	22(75.9)	10(50.0)
活化部分凝血酶时间(s)			0.684	0.408
＞37	7(24.1)	7(35.0)
≤37	22(75.9)	13(65.0)
INR			0.000	1.000
＞1.5	4(13.7)	2(10.0)
≤1.5	25(86.3)	18(90.0)

变量	非EAD组(29例)	EAD组(20例)	χ ²值	P值
肝功能
尿素(mmol/L)			0.020	0.888
＞28	3(10.3)	1(5.0)
≤28	26(89.7)	19(95.0)
肌酐(μmol/L)			0.285	0.593
＞300	3(10.3)	4(20.0)
≤300	26(89.7)	16(80.0)
AST(U/L)			0.285	0.593
＞200	3(10.3)	4(20.0)
≤200	26(89.7)	16(80.0)
ALT(U/L)			4.819	0.028^a
＞200	1(3.4)	6(30.0)
≤200	28(96.6)	14(70.0)
谷氨酰转移酶(U/L)			1.880	0.170
＞120	3(10.3)	6(30.0)
≤120	26(89.7)	14(70.0)
碱性磷酸酶(U/L)			0.000	1.000
＞150	6(20.7)	4(20.0)
≤150	23(79.3)	16(80.0)
乳酸脱氢酶(U/L)			0.000	1.000
＞250	25(86.2)	17(85.0)
≤250	4(13.8)	3(15.0)
TB(μmol/L)			4.851	0.028^a
＞17.1	7(24.1)	11(55.0)
≤17.1	22(75.9)	9(45.0)
白蛋白(g/L)			1.090	0.296
＜30	13(44.8)	12(60.0)
≥30	16(55.2)	8(40.0)
生化
钠(mmol/L)			2.959	0.085
＞150	9(34.5)	12(60.0)
≤150	20(65.5)	8(40.0)
钾(mmol/L)			0.868	0.351
＞5.5	2(6.9)	4(20.0)
≤5.5	27(93.1)	16(80.0)
氯(mmol/L)			7.871	0.005^a
＞115	6(20.7)	12(60.0)
≤115	23(79.3)	8(40.0)
钙(mmol/L)			3.528	0.060
≤2.2	16(55.2)	17(85.0)
＞2.2	13(44.8)	3(15.0)
变量	非EAD组(29例)	EAD组(20例)	χ ²值	P值
血气分析
pH值
＜7.4	6(20.7)	4(20.0)	0.000	1.000
≥7.4	23(79.3)	16(80.0)
氧分压(mmHg)			1.271	0.260
＜80	23(79.3)	19(95.0)
≥80	6(20.7)	1(1.0)
二氧化碳分压(mmHg)			0.017	0.896
＞45	6(20.7)	3(15.0)
≤45	23(79.3)	17(85.0)
碳酸氢根(mmol/L)			0.000	1.000
＜22	6(20.7)	4(20.0)
≥22	23(79.3)	16(80.0)
碱剩余(mmol/L)			0.041	0.840
＜-3	8(27.6)	5(25.0)
≥-3	21(72.4)	15(75.0)
乳酸(mmol/L)			4.135	0.052
＞2.0	17(58.6)	5(25.0)
≤2.0	12(41.4)	15(75.0)
血常规
白细胞(×10⁹/L)			3.145	0.076
≤10	5(17.2)	8(40.0)
≥10	24(82.8)	12(60.0)
血红蛋白(g/L)			0.088	0.767
＜120	24(82.8)	18(90)
≥120	5(17.2)	2(10.0)
血小板(×10⁹/L)			0.993	0.319
＜100	9(31.3)	9(45.0)
≥100	20(68.7)	11(55.0)
中性粒细胞比例			0.034	0.854
＞80%	21(72.4)	14(70.0)
≤80%	8(27.6)	6(30.0)
红细胞(×10¹²/L)			0.356	0.551
＜3.0	12(41.3)	10(50.0)
≥3.0	17(58.7)	10(50.0)
出凝血常规
凝血酶原时间(s)			3.494	0.062
＞14	7(24.1)	10(50.0)
≤14	22(75.9)	10(50.0)
活化部分凝血酶时间(s)			0.684	0.408
＞37	7(24.1)	7(35.0)
≤37	22(75.9)	13(65.0)
INR			0.000	1.000
＞1.5	4(13.7)	2(10.0)
≤1.5	25(86.3)	18(90.0)

变量	非EAD组(29例)	EAD组(20例)	χ ²值	P值
手术时长(min)			0.020	0.888
＞600	3(10.3)	1(5.0)
≤600	26(89.7)	19(95.0)
术中出血(ml)			0.000	1.000
＞1 500	16(55.2)	6(30.0)
≤1 500	13(44.8)	14(70.0)
输入红细胞(IU)			0.684	0.408
＞5	7(24.1)	7(35.0)
≤5	22(75.9)	13(65.0)
无肝期(min)			0.000	0.990
＞45	16(55.2)	11(55.0)
≤45	13(44.8)	9(45.0)
呼吸支持时间(h)			0.020	0.888
＞12	3(10.3)	1(5.0)
≤12	26(89.7)	19(95.0)
术后ICU住院时间(h)			1.090	0.296
＞24	13(44.8)	12(60.0)
≤24	16(55.2)	8(40.0)

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