Analysis of risk factors of early allograft dysfunction after deceased donor liver transplantation in children
10.3760/cma.j.cn421203-20240613-00147
- VernacularTitle:遗体捐献供肝儿童肝移植术后早期移植物功能不全的危险因素分析
- Author:
Guofeng ZHANG
1
;
Wei GAO
1
Author Information
1. 天津市第一中心医院肝移植科 天津市器官移植重点实验室，天津 300192
- Publication Type:Journal Article
- Keywords:
Liver transplantation;
Pediatric liver transplantation;
Early allograft dysfunction;
Risk factor;
Prognosis
- From:
Chinese Journal of Organ Transplantation
2025;46(2):141-149
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the risk factors for early allograft dysfunction (EAD) following deceased donor liver transplantation in pediatric recipients.Method:A retrospective analysis was conducted on 390 pediatric liver transplant recipients who underwent deceased donor liver transplantation at Tianjin First Central Hospital between January 1, 2018, and December 31, 2023. Patients were categorized into the EAD group (152 cases) and the non-EAD group (238 cases) based on the presence or absence of EAD. Patient and graft survival rates were compared between the two groups. Multivariate logistic regression analysis was performed to identify independent risk factors for EAD. A nomogram was constructed and validated using receiver operating characteristic (ROC) curves to assess predictive performance.Result:Among the 390 pediatric liver transplant recipients, 152 cases (38.97%) developed EAD. Postoperative intensive care unit (ICU) stay and duration of ventilatory support were significantly longer in the EAD group compared to the non-EAD group ( P<0.05). The 1-month (90.8% vs. 97.1%) and 3-month (90.7% vs. 95.4%) cumulative graft survival rates were significantly lower in the EAD group than in the non-EAD group ( χ2=4.36, P=0.037). However, the 1-month (93.4% vs. 97.9%) and 3-month (92.8% vs. 96.6%) cumulative recipient survival rates showed no statistically significant difference between the two groups ( χ2=3.15, P=0.076). Multivariate logistic regression analysis identified recipient weight ( P=0.0091), preoperative blood lactate level ( P=0.0065), donor age ( P=0.0434), operative duration ( P<0.01), cold ischemia time ( P<0.01), and portal venous flow (PVF) before abdominal closure ( P=0.0241) as independent risk factors for EAD. The combination of these factors demonstrated good predictive performance for EAD, with an area under the curve (AUC) of 0.75 (95% CI: 0.70~0.80, P<0.05) . Conclusion:Recipient weight, preoperative blood lactate levels, donor age, operative duration, cold ischemia time, and PVF before abdominal closure are significantly associated with the development of EAD in pediatric recipients undergoing deceased donor liver transplantation. Optimizing preoperative donor and recipient assessment, as well as refining surgical procedures, may help reduce the incidence of EAD and improve post-transplant outcomes.
