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Objective To evaluate the effect of extracorporeal membrane oxygenation (ECMO) on early allograft dysfunction (EAD) after heart transplantation. Methods Clinical data of 614 heart transplant recipients were retrospectively analyzed. All recipients were divided into the ECMO group (n=43) and non-ECMO group (n=571) according to postoperative application of ECMO. In the ECMO group, the conditions of recipients undergoing ECMO after heart transplantation were summarized. Perioperative status and long-term prognosis of recipients were compared between two groups. Results Among 43 recipients undergoing ECMO, 17 cases underwent thoracotomy due to bleeding, 10 cases of infection, 4 cases of venous thrombosis of the lower limbs, and 1 case of stroke, respectively. Twenty-six recipients were recovered and discharged after successful weaning from ECMO, six died during ECMO support, six died after weaning from ECMO, five received retransplantation due to unsuccessful weaning from ECMO, and only one survived after retransplantation. Compared with the non-ECMO group, intraoperative cardiopulmonary bypass duration was significantly longer, the proportion of recipients requiring postoperative intra-aortic balloon pump (IABP), dialysis due to renal insufficiency, reoperation for hemostasis, infection, mechanical ventilation time≥96 h and tracheotomy was significantly higher, and the length of postoperative intensive care unit (ICU) stay was significantly longer in the ECMO group (all P < 0.05). The survival rate after discharge and 90-d survival rate in the ECMO group were 63% and 96%, significantly lower than 97% and 100% in the non-ECMO group (both P < 0.05). Survival analysis showed that the long-term survival rate in the ECMO group was significantly lower than that in the non-ECMO group (P < 0.05). After excluding the recipients who died within 90 d after heart transplantation, no significant difference was observed in the long-term survival rate (P > 0.05). Conclusions ECMO is an effective treatment of EAD after heart transplantation. The short-term survival rate of recipients using ECMO after heart transplantation is lower than that of those who do not use ECMO, and there is no significant difference in long-term survival of recipients surviving 90 d after heart transplantation.
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Objective:To explore the characteristics of postoperative hemodynamic changes in patients with early allograft dysfunction (EAD), and to provide clinical imaging support for the early diagnosis of EAD.Methods:A total of 907 patients who underwent liver transplantation in Tianjin First Central Hospital from December 2012 to June 2021 were retrospectively selected, and they were divided into EAD group (361 cases) and non-EAD group (546 cases) according to EAD diagnostic criteria. The peak systolic velocity(PSV) of the hepatic artery, end-diastolic velocity(EDV) of the hepatic artery, resistance index(RI), S/D(PSV/EDV), diameter of the portal vein(PVD), velocity of the portal vein(PVV), diameter of the middle hepatic vein(MHVD), velocity of the middle hepatic vein(MHVV), the diameter of the right hepatic vein(RHVD), and the velocity of the right hepatic vein (RHVV) were collected from 1 to 7 days after operation (a total of 5 573 ultrasound examination results), and the differences in ultrasound hemodynamic parameters were compared between the two groups. The correlation of S/D<2, PSV<25 cm/s, PVV<15 cm/s, MHVV or RHVV<15 cm/s within 3 days after operation with the occurence of EAO were analyzed by multivariate Logistic regression analysis.Results:①The PSV and EDV of the hepatic artery in the EAD group and the non-EAD group showed a slow upward trend at 1-7 days after operation, while the hepatic artery RI and PVV showed a downward trend, the MHVV and RHVV did not fluctuate significantly. ②The hepatic artery in the EAD group showed low-resistance blood flow in the early postoperative period, and the EDV were significantly higher than that in the non-EAD group on 1 d, 2 d, 3 d and 5 d, RI was significantly lower than that of the non-EAD group (all P<0.05); At 4 d, 6 d and 7 d, there was no significant differences of EDV and RI between the two groups(all P>0.05). The PSV of the EAD group was higher than that of the non-EAD group on 3 d ( P<0.05). Among the parameters of portal vein blood flow, the PVV in the EAD group was significantly higher than that in the non-EAD group on 1 d ( P<0.05), and there was no significant difference of PVD between the two groups at day 1-7. Among the parameters of hepatic venous blood flow, the MHVV and RHVV in the EAD group were significantly lower than those in the non-EAD group (all P<0.05), there was no significant difference between the two groups of MHVD and RHVD at 1-7 days. ③The incidence of grafted hepatic artery S/D<2 within 3 days after operation in EAD group was higher than that in non-EAD group. Binary Logistic regression multivariate analysis showed that the occurrence of grafted hepatic artery S/D<2 within 3 days after operation was significantly correlated with the occurrence of EAD[Exp(B)=1.878, P<0.05]. Conclusions:Patients who develop EAD after liver transplantation show low-resistance blood flow in the hepatic artery during the perioperative period, and the occurrence of hepatic artery S/D<2 within 3 days after operation can early predict the occurrence of EAD.
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Liver transplantation is the most effective treatment for end-stage liver disease, and early graft dysfunction often occurs after surgery. Early liver dysfunction after liver transplantation has become one of the complications after liver transplantation, which seriously affects the graft and patient survival. Therefore, reducing its occurrence can be an important means to improve the prognosis of recipients after liver transplantation. This paper discusses the research progress on the definition, influencing factors, and prognosis and prediction model in order to provide better prevention and effective reference for improving the success rate and prognosis of early liver dysfunction in recipients after liver transplantation.
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Objective The incidence of early allograft dysfunction (EAD) following deceased donor liver transplantation (DDLT) is high and affects the prognosis of the recipient. This study aimed to investigate the risk factors for EAD following DDLT. Methods This retrospective study included 79 cases of liver transplantation performed in the No. 900 Hospital of PLA Joint Logistic Support Force from January 2015 to December 2017. We collected the clinical data on the donors and recipients, propensity-score matched the pre- and intra-operative data on the recipients, and analyzed the risk factors for EAD identified among 17 donor-related variables. Results EAD was found in 26 (32.9%) of the recipients. Univariate analysis showed statistically significant differences between the EAD and non-EAD groups in the body mass index, warm ischemia time, and cold ischemia time of the donors (P < 0.05), and so did multivariate logistic regression analysis in the levels of serum sodium and alanine aminotransferase and warm ischemia time of the donors (P < 0.05). The best cut-off values of the serum sodium level and warm ischemia time of the donors for predicting post-operative EAD were 152.7 mmol/L and 8 min, respectively. Conclusion The serum sodium and alanine aminotransferase levels and warm ischemia time of the donors are independent risk factors for EAD after DDLT. The serum sodium level and warm ischemia time of the donors play an important role in evaluating the quality of deceased donor organs.
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Objective To determine the risk factors associated with early allograft dysfunction (EAD) after liver transplantation. Methods We retrospectively analyzed the records of 138 patients who underwent liver transplantation from January 2006 to October 2016 in our department. Transplant recipients were divided into two groups:those who met the diagnostic criteria of EAD (EAD group) and those who did not (non-EAD group). We compared blood flow into the transplanted livers and other clinical features between the two groups using univariate and multivariate analysis. Results Intraoperative portal vein flow (PVF) maximum was significantly different between the two groups. Multivariate analysis revealed that intraoperative PVF maximum ＜1 600 mL/min was the only independent risk factor for the occurrence of EAD after liver transplantation in this cohort. Conclusion Intraoperative PVF maximum ＜1 600 mL/min is an independent risk factor for the occurrence of EAD after liver transplantation. Measuring intraoperative blood flow into the transplanted liver in liver transplant recipients may help identify patients at risk for developing EAD.
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Objective To explore the correlation between main indicators of donor liver and early prognosis after liver transplantation.Methods The clinical data of 166 donors and recipients of post-mortem organ donation (DD) from June 2017 to June 2018 were retrospectively analyzed.The effects of donor age,sex,body mass index,serum sodium level,total bilirubin,prothrombin time and international standardized ratio on early allograft dysfunction (EAD) in liver transplant recipients were investigated.According to the culture results of donor liver preservation solution,the results were divided into positive group and negative group.Combined with the culture results of blood,sputum and drainage fluid after liver transplantation,the early infection rate of recipients in the two groups was observed.Results Univariate analysis showed that preoperative donor bilirubin total ＞17.1 mmol/L and donor cold ischemia time ＞8 h were risk factors for postoperative EAD in transplant recipients.Multivariate analysis showed that donor cold ischemia time ＞8 h was an independent risk factor for postoperative EAD in liver transplant recipients;the incidence of EAD in the group with cold ischemia time ＞8 h was significantly higher than that in the group with cold ischemia time ≤8 h (26.3％ vs.7.0％;P =0.003).The positive rate of postoperative sputum culture and drainage fluid culture in the donors with positive donor culture was 43.9％ and 48.8％,respectively,which was significantly higher than that in the negative group (10.7％ and 13.1％).The difference was statistically significant (P =0.000,P =0.000).The positive rate of postoperative blood culture in the positive group and the negative group was 12.2％ and 6.0％ with the difference being not statistically significant (P =0.161).Conclusion Cold ischemia time of the donor ＞8 h is an independent risk factor for EAD in recipients after liver transplantation.Shortening the cold ischemia time of donor liver can reduce the incidence of postoperative EAD in recipients.The culture results of preservation solution have a certain guiding effect on the postoperative anti-infective treatment of the recipients.
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Objective To summarize the clinical efficacy of liver transplantation from donation after cardiac death (DCD). Methods Clinical data of both the donors and recipients (n=182) undergoing liver transplantation from DCD were retrospectively analyzed. According to the type of primary diseases, 182 recipients were divided into the benign group (n=135) and hepatocellular carcinoma (liver cancer) group (n=47). Perioperative conditions, 1- and 3-year survival rate of the recipients were statistically compared between two groups. Clinical prognosis and the incidence of postoperative complications of the recipients were summarized. Postoperative complications mainly included early allograft dysfunction (EAD), vascular complications, acute kidney injury (AKI), pulmonary infection, acute rejection, cytomegalovirus (CMV) infection and billiary tract complication. Results No statistical significance was identified in the anhepatic phase, operation time and length of intensive care unit (ICU) stay between two groups (all P>0.05). The 1-year survival rates of the 182 recipients and grafts were 93.1%, and 84.9% for the 3-year survival rates. In the benign group, the 1- and 3-year survival rates of the recipients were 92.5% and 88.1%. In the liver cancer group, the 1-year survival rate of the recipients was 95%, 91% for the disease-free survival rate, and 78% for the 3-year survival rate, respectively. No statistical significance was noted in the overall survival rate of the recipients between two groups (P=0.879). In terms of postoperative complications, billiary tract complications occurred in 26 patients, vascular complications in 14, AKI in 34, pulmonary infection in 22, acute rejection in 11, EAD in 11 and CMV infection in 10. The incidence of postoperative billiary tract complications in patients with T-tube insertion was significantly lower than that in their counterparts without T-tube insertion (8% vs. 19%, P<0.05). Conclusions Liver transplantation from DCD is an efficacious treatment for end-stage liver diseases and liver cancer, which yields relatively high short-term clinical efficacy.
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Objective To investigate the correlation between the elastographic characteristics of liver and postoperative function of liver allografts.Methods Forty-eight cases of liver transplantation from The First Affiliated Hospital of Sun Yat-sen University were analyzed,Shear wave elastography (SWE) was performed before operation or at one week or one month post-operation.Liver function was evaluated by measuring alanine aminotransferase (ALT),aspartate transaminase (AST),total bilirubin (TBIL),γ-glutamine transferase (GGT),albumin (ALB),alkaline phosphatase (ALP),prothrombin time (PT),activated partial thromboplastin time (APTT),and international normalized ratio (INR).Early allograft dysfunction (EAD) was also analyzed with reference to SWE among liver transplant recipients.Results SWE at one week after transplantation was significantly correlated with TBIL (r=0.525 6,P<0.01),APTT (r=0.668 3,P<0.000 1),PT (r=0.593 7,P=0.000 1),INR (r=0.609 6,P<0.000 1) and prealbumin (r=-0.464 1,P<0.01).However,no significant correlation was observed between pre-operative SWE and parameters of post-operative liver function.SWE in EAD patients was higher than that of patients without EAD (17.60±1.09 kPa vs.13.38±0.99 kPa,P<0.01).The optimal cut-off value of SWE at one week post-operation was 14.85 kPa.Conclusion Postoperative SWE is significantly correlated with postoperative liver function tests and EAD,suggesting SWE is a potential test for evaluating the quality of liver allografts.
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Objective To summarize the clinical experience and effect analysis of liver transplantation from donation after citizen’s death. Methods Clinical data of 76 donors and 78 recipients of liver transplantation from donation after citizen’s death completed in Liver Transplantation Center of West China Hospital,Sichuan University from March 2012 to November 2015 were analyzed retrospectively.The functional recovery of early allografts in liver transplant recipients was observed and the risk factors causing early allograft dysfunction (EAD)were analyzed.In addition,long﹣term survival of allografts and recipient as well as complications was observed. Results The incidence of postoperative EAD was 36%(28 /78)in 78 recipients.High total bilirubin (TB)and long cold ischemia time constituted the risk factors of EAD. Survival rate of the recipients was 92% (72 /78)during perioperation,and 6 cases died,of which 4 cases died of primary graft dysfunction,1 case of upper gastrointestinal hemorrhage and 1 case of pulmonary infection.Postoperative abdominal infection occurred in 5 cases,with biliary stricture in 3 cases and vascular thrombosis in 2 cases.One case died,and the rest were improved after corresponding treatment.The 1﹣year survival rate of the recipients was 84.2% and 2﹣year survival rate was 80% after operation. Conclusions Liver transplantation from donation after citizen’s death realizes favorable short and long﹣term effects,which can be regarded as a good source of donor livers.Important measures such as controlling the preoperative quality of donor liver and shortening the cold ischemia time can improve the clinical effect.