成人因C型肝炎肝硬化接受第一次原位肝移植早期移植肝流失的預測因子

Predictors of Early Graft loss in the Adult First Orthotopic Liver Transplant Recipients with Hepatitis C-related Cirrhosis

巫奕儒(Yi-Ju Wu)

指導教授 ： 鄭雅文 ； 周明智

中山醫學大學/醫學院/醫學研究所/碩士(2009年)

https://doi.org/10.6834/CSMU.2009.00130

摘要

背景: 術前和術中的因素是肝移植後的強烈預後因子。而C型肝炎病毒有關的末期肝疾病在美國是最常被移植的肝疾病。我們目標是想找出這些成人因C型肝炎病毒的末期肝疾病經第一次原位肝移植造成早期移植肝流失的危險因素。
材料與方法: 追遡回顧2002年1月1日至2007年6月30日期間在洛杉磯大學醫學中心接受肝移植的成人病患(大於18歲)。在這些患者中，只採用因C型肝炎病毒繼發末期肝病並接收死亡捐贈器官的病例，且經過單一顆和第一次完整的原位肝移植。我們分別在3個月和12個月評估早期移植肝流失。經單變項係數分析 (p<0.1)可得到一些潛在因子，這些潛在因子再進入回歸多變項分析可得到有意義的危險因素 (p<0.05)。
結果: 總共有344位病人符合這選擇條件。其中有39位病人(11.3%) 在3個月內移植肝流失而被分配進入EGL-3這組。另外有67位 (19.5%)在12個月內移植肝流失而被分配進入EGL-12這組。經過分析後，術前7項獨立危險因素包括: 移植前感染、上腹部手術病史、腹膜炎病史、肺動脈高壓、心臟疾患、移植前氣管插管和捐贈者最後嚴重高血鈉濃度 (156~176 mEq/l)。術中的3項獨立危險因素包括高需求的血小板輸液 (>20u)、貧乏的尿排量 (<250ml) 和貧乏的立即膽汁分泌量。
結論: 這些獨立危險因素可以用來評估C型肝炎病毒繼發末期肝病成人經第一次原位肝移植造成的早期移植肝流失。

關鍵字

末期肝疾病 ； 原位肝移植 ； 早期移植肝流失

並列摘要

Background:
Preoperative and intraoperative factors are the strong predictors of outcome in the first few months after transplant. HCV-related end stage liver disease (ESLD) is the most common disease for orthotopic liver transplant (OLT) in America. Our objective is to identify the risk factors of early graft loss (EGL) after first orthotopic liver transplantation (OLT) for adult recipients with ESLD secondary to HCV.
Materials and Methods:
Retrospectively we collected the adult patients of HCV-related cirrhosis from January 1, 2002 to June 30, 2007 at UCLA medical center. Only the adult patients (≥18y/o) with ESLD secondary to HCV, receiving deceased donors, single and first whole OLT were included. We assessed the EGL at 3 months and 12 months. The potential (p<0.1) variables after a univariate analysis were obtained. The significant risk factors (p<0.05) were derived from a multivariate logistic regression for the potential variables.
Results:
In all, 344 patients were suitable for the inclusion criteria. For the 3-month EGL, 39 (11.3%) patients were assigned into EGL-3 group. For the 12-month EGL, 67 (19.5%) patients were into EGL-12 group. Preoperatively 7 independent risk factors were obtained, including pre-transplant infection, prior upper abdomen surgery, history of peritonitis, pulmonary hypertension, cardiac disease, intubation prior to transplant and high concentration (156~176 mEq/l) of last serum Na level of donors. Intra-operatively 3 independent risk factors were obtained, including high requirement (>20u) of platelet transfusion, poor urine output (<250ml), and poor amount of immediate bile production.
Conclusion:
These risk factors can provide an assessment of anticipating EGL after first OLT for adult recipients with ESLD secondary to HCV.

並列關鍵字

end stage liver disease ； orthotopic liver transplantation ； early graft loss

參考文獻

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