Analysis of risk factors of early pulmonary complications after orthotopic liver transplantation: a report of 313 cases / 中华器官移植杂志

Objective:To explore the effects of donor, basic recipient characteristics and intraoperative findings before orthotopic liver transplantation(OLT)on postoperative pulmonary complications and the influence of postoperative pulmonary complications on postoperative outcomes and long-term survival of patients.Methods:From January 2016 to December 2019, clinical data were retrospectively reviewed for 313 OLT recipients at First Affiliated Hospital, Nanjing Medical University.According to clinical manifestations, laboratory parameters and imaging findings within 7 days post-operation, they were divided into two groups of with and without postoperative pulmonary complications.Univariate and multivariate Logistic regression analyses were performed for general parameters of donors/recipients and perioperative variables of recipients in two groups.And Kaplan-Meier survival analysis was conducted for postoperative survival of two groups.Results:Multiariate Logistic regression analysis indicated that age, concurrent chronic diseases, low preoperative platelet count, intraoperative massive bleeding(>1 500 ml)and severe hypotension after perfusion were all independent risk factors for postoperative pulmonary complications.Compared with those without postoperative pulmonary complications, intensive care unit(ICU)stay, postoperative mechanical ventilation duration and hospital stay were significantly prolonged in patients with postoperative pulmonary complications.And rate of re-intubation, incidence of acute kidney injury and hospital mortality spiked markedly( P<0.05). Among OLT patients with benign liver diseases, overall survival rate of patients without postoperative pulmonary complications was significantly better than that of those with postoperative pulmonary complications( P<0.05). Conclusions:Age, concurrent chronic diseases, low preoperative platelet count, massive intraoperative bleeding(>1 500 ml)and severe hypotension after perfusion boost the risks of early postoperative pulmonary complications and adversely affect the outcomes of OLT recipients.

Postoperative serum triglyceride levels in predicting risk of new-onset diabetes mellitus in patients following liver transplantation / 浙江大学学报·医学版

To investigate the postoperative serum triglyceride (TG) levels in predicting the risk of new-onset diabetes mellitus (NODM) in patients following allogeneic liver transplantation. One hundred and forty three patients undergoing allogeneic liver transplantation in Shanghai General Hospital from July 2007 to July 2014 were enrolled in this study. The NODM developed in 33 patients after liver transplantation. The curve of dynamic TG levels in the early period after liver transplantation was generated. Independent risk factors of NODM were determined by univariate and multivariant logistic regression analyses. The clinical value of TG in predicting NODM was analyzed by area under the ROC curve (AUC). Serum TG levels were gradually rising in the first week and then reached the plateau phase (stable TG, sTG) in patients after surgery. The sTG in NODM group were significantly higher than that in non-NODM group (=-2.31, <0.05). Glucocorticoid therapy (=4.054, <0.01), FK506 drug concentration in the first week after operation (=3.482, <0.05) and sTG (=3.156, <0.05) were independent risk factors of NODM. ROC curve analysis showed that the AUC of sTG in predicting NODM was 0.72. TG shows a gradual recovery process in the early period after liver transplantation, and the higher TG level in stable phase may significantly increase the risk of NODM in patients.

One case the nursing of children organ donations after cardiac death donation of liver in adults with portal venous thrombosis after liver transplantation / 中国实用护理杂志

Objective To investigate the nursing of the adult recipients who accept children organ donations after cardiac death(DCD)complicated with portal venous thrombosis after liver transplantation. Methods We retrospectively analyzed 1 case completed in 2015 related to the adult recipients who accept children organ donations after cardiac death with portal venous thrombosis after liver transplantation in clinical situation,in view of the portal vein thrombosis of portal vein catheter thrombolysis,portal vein carotid stenting, close observation and nursing are used for patients′condition change. Results After positive clinical therapy and careful nursing,portal venous thrombolysis effect is good, and portal venous blood flowing after carotid stenting,clinical symptoms were alleviated. The liver function recovered well after surgery, and the patient discharged successfully,followed by regular visits from the hospital. Conclusions Children organ donations after cardiac death for liver can be successfully applied in the adult recipients,but the understanding of related complications after surgery need to be strengthened.The symptom observation,early detection,active nursing intervention,are conducive to the prognosis of patients.