Investigation of the Influences of Donor and Recipient Conditions on MELD Scores in Patients Undergoing Donor Liver Transplantation after Cardiac Death

doi:10.12114/j.issn.1007-9572.2018.00.024

Abstract

Abstract: Background　In recent years，the score of model for end-stage liver disease （MELD） which explores high-risk factors of the incidence of complication and mortality after liver transplantation has attracted a lot of attention. Most studies focus on the effect of preoperative conditions on postoperative recovery at present.In this study，we investigated the effect of preoperative conditions on the changes of MELD score after liver transplantation and provided new ideas for the recovery of recipients after transplantation.Objective　To investigate the effects of the preoperative conditions of donors after cardiac death （DCD） on MELD scores after liver transplantation.Methods　A total of 25 DCD liver transplantation cases in the Institute of Organ Transplantation，Tongji Hospital，Tongji Medical College，Huazhong University of Science and Technology were retrospectively selected from September 2013 to September 2015.Data on donor sex，age，duration of ICU treatment，preoperative serum indices 〔alanine aminotransferase （ALT），aspartate aminotransferase （AST），direct bilirubin （DBiL），total bilirubin （TBiL），white blood cell count （WBC），and hemoglobin （Hb）〕，and the MELD scores of recipients before and after transplantation were collected and analyzed.Results　The decreases in the postoperative MELD scores of male （n=19） and female （n=6） donors were（2.80±1.32）% and （1.40±0.66）%，and the difference was significant（t=2.476，P=0.021）.There were 15 donors <45 years old and 10 donors ≥45 years old；the decreases in the postoperative MELD scores of the two groups were（2.73±1.26）% and （2.07±1.40）%，and were not significantly different between groups（t=-1.210，P=0.242）.Regarding the duration of ICU treatment，there were 3 cases <5 d，14 cases 5-10 d and 8 cases >10 d；the decreases in the postoperative MELD scores of the three groups were （2.30±1.38）%，（2.85±0.85）% and（2.94±1.76）%，and were not significantly different among groups （F=0.957，P=0.516）.There was no linear correlation between the decreases in the postoperative MELD scores of the recipients and the age，duration of ICU treatment，preoperative AST，DBiL，WBC and Hb of the donors，as well as the preoperative MELD scores of the recipients （r=-0.344，P=0.093；r=-0.294，P=0.154；r=-0.271，P=0.090；r=-0.181，P=0.386；r=-0.310，P=0.096；r=-0.205，P=0.325；r=-0.219，P=0.294）.The preoperative ALT and TBiL levels of the donors negatively correlated with the decreases in the postoperative MELD scores of the recipients （r=-0.301，P=0.044；r=-0.372，P=0.012）.Linear regression analysis showed that the preoperative levels of ALT，AST and TBiL of the donors correlated with the decreases in the postoperative MELD scores of the recipients （P<0.05）.Conclusion　The higher levels of ALT，AST and TBiL before transplantation，the lower decreases in the postoperative MELD scores of recipients，and the slower recovery of recipients.A high level of ALT，AST or TBiL is the main risk factor for complications in liver transplantation.

Key words: Liver transplantation, End stage liver disease, Tissue donors, Alanine aminotransferase, Aspartate aminotransferases, Bilirubin

摘要： 背景　近年来应用终末期肝病模型（MELD）评分探讨影响肝脏移植术后并发症发生率和病死率的高危因素成为热点，目前研究多集中于受体术前情况对术后恢复的影响。本研究通过研究供体术前情况对受体肝脏移植术后MELD评分变化的影响，为受体肝脏移植术后病情恢复提供新的思路。目的　探讨心脏死亡器官捐献（DCD）供体术前情况对受体肝脏移植术后MELD评分的影响。方法　回顾性选取2013年9月—2015年9月华中科技大学同济医学院附属同济医院器官移植研究所DCD肝脏移植供体25例，收集供体的性别、年龄、重症监护室（ICU）治疗时间、术前血清指标〔丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、直接胆红素（DBiL）、总胆红素（TBiL）、白细胞计数（WBC）及血红蛋白（Hb）〕和受体肝脏移植术前、术后MELD评分，并进行相关性分析。结果　男性供体19例、女性供体6例，受体肝脏移植术后MELD评分下降速度分别为（2.80±1.32）%和（1.40±0.66）%，差异有统计学意义（t=2.476，P=0.021）；供体年龄<45岁15例，≥45岁10例，受体肝脏移植术后MELD评分下降速度分别为（2.73±1.26）%和（2.07±1.40）%，差异无统计学意义（t=-1.210，P=0.242）；供体ICU治疗时间<5 d 3例，5~10 d 14例，>10 d 8例，受体肝脏移植术后MELD评分下降速度分别为（2.30±1.38）%、（2.85±0.85）%、（2.94±1.76）%，差异无统计学意义（F=0.957，P=0.516）。供体年龄、ICU治疗时间、术前AST、DBiL、WBC、Hb水平、受体肝脏移植术前MELD评分与受体肝脏移植术后MELD评分下降速度均无直线相关关系（r=-0.344，P=0.093；r=-0.294，P=0.154；r=-0.271，P=0.090；r=-0.181，P=0.386；r=-0.310，P=0.096；r=-0.205，P=0.325；r=-0.219，P=0.294）。供体术前ALT、TBiL水平与受体肝脏移植术后MELD评分下降速度呈负相关（r=-0.301，P=0.044；r=-0.372，P=0.012）。线性回归分析显示，供体术前ALT、AST、TBiL水平与受体肝脏移植术后MELD评分下降速度相关（P<0.05）。结论　DCD供体术前ALT、AST、TBiT水平越高，受体肝脏移植术后MELD评分下降速度越低，患者恢复越慢。DCD供体术前ALT、AST、TBiT水平是肝脏移植术后并发症发生的主要高危因素。

关键词: 肝移植, 终末期肝病, 组织供者, 丙氨酸氨基转移酶, 天冬氨酸氨基转移酶类, 胆红素

FANG Dazheng,HU Wei,ZHANG Bo. Investigation of the Influences of Donor and Recipient Conditions on MELD Scores in Patients Undergoing Donor Liver Transplantation after Cardiac Death　[J]. Chinese General Practice, 2019, 22(2): 162-166. DOI: 10.12114/j.issn.1007-9572.2018.00.024.
方大正,胡伟,张波. 心脏死亡器官捐献供体情况对受体肝脏移植术后终末期肝病模型评分影响研究[J]. 中国全科医学, 2019, 22(2): 162-166. DOI: 10.12114/j.issn.1007-9572.2018.00.024.

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