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

doi:10.3877/cma.j.issn.1674-0793.2016.05.008

Abstract

Abstract:

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

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.

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Figures/Tables 4

References 14

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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)	?	?

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)	?	?

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

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

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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