Clinical Characteristics And Prognostic Factors Of Liver Transplantation In Patients With Drug-induced Liver Disease

Objective:Drug induced liver disease(DILD)refers to the liver damage caused by drugs or their metabolites.Accounting for 20%to 50%of non viral hepatitis is one of the most important causes of fulminant hepatic failure[1].Severe drug-induced liver disease can cause liver failure,severe cholestasis and chronic liver injury,which may be considered as a liver transplantation for[1].However,the clinical features of liver transplantation in patients with drug-induced liver disease are not clear,and the risk factors associated with the prognosis are not fully established.There is still a lack of research on the treatment of patients with drug-induced liver transplantation.Methods:It is a retrospective analysis of 20 hospitalized patients from the First Affiliated Hospital of Zhejiang University medical college were clinical diagnosis and postoperative pathological diagnosis of drug-induced liver disease and liver transplantation in the treatment from January 2008 to December 2015,and 40 cases in the same period for the first time for liver transplantation in the treatment of hepatitis B cirrhosis without tumor and 40 cases of hospitalized patients for the first time for liver transplantation in the treatment of chronic hepatitis B activity in acute exacerbation and without tumor patients.Cases were included in the case group,the hepatitis B cirrhosis control group and the chronic hepatitis B activity in acute exacerbation control group.To compare the clinical characteristics and prognosis of the case group with hepatitis B cirrhosis control group and the chronic hepatitis B activity in acute exacerbation control group,to find out the clinical features of drug-induced liver transplantation.The risk factors of poor prognosis in patients with drug-induced liver disease after liver transplantation were analyzed by comparing the clinical characteristics of the death group and the survival group within 50 days in the case group.And a multivariate logistic regression model was developed to assess the risk of early death(50 days)after liver transplantation in patients with drug-induced liver disease.Results:Cases group and hepatitis B cirrhosis control group in gender,with or without preoperative hepatic encephalopathy,preoperative Child score,preoperative MELD scores,preoperative serum creatinine,prothrombin time,international normalized ratio,preoperative total bilirubin,preoperative serum ALT and AST,preoperative and postoperative alkaline phosphatase 1 week after operation,alanine-aminotransferase 1 weeks after operation,total bilirubin,1 week after operation,serum albumin creatinine 1 weeks after operation,there was significant difference(P<0.05),and significant difference in total mortality(P<0.05).No significant difference in the early complications and late complications,biliary complications,50 days mortality,acute rejection of postoperative reaction.The case group and the chronic hepatitis B activity in acute exacerbation control group in gender,preoperative MELD score,preoperative albumin creatinine 1 weeks after operation,there was significant difference(P<0.05),the total mortality rate,50 days mortality,biliary complications,acute rejection,early postoperative complications and late complications has no obvious difference.Univariate analysis showed that survival within 50 days group and the death within 50 days of the case group,the preoperative patients with severe heart and lung diseases preoperative,creatinine>104umol/L 1 week after the operation,AST>300U/L 1 week of operation,TB>80umol/L 1 week after the operation,the four factors are risk factors of died 50 days after liver transplantation.Further multivariate logistic regression analysis showed that the four were independent risk factors.But because of too few cases,it is impossible to construct an effective logistic regression model.Conclusion:To compare the clinical characteristics and prognosis of liver transplantation for Drug-induced liver disease with hepatitis B cirrhosis and the chronic hepatitis B activity in acute exacerbation,in the various indicators of gender and preoperative and postoperative respectively are different,but in the early postoperative period(within 50 days)mortality,acute rejection,biliary complications,postoperative complications and late complications has no significant difference.The patients with severe heart and lung diseases preoperative,creatinine>104umol/L 1 week after the operation,AST>300U/L 1 week of operation,TB>80umol/L 1 week after the operation,the four factors are risk factors of died within 50 days after liver transplantation.At present,a large number of retrospective studies are needed to further construct the logistic regression model,and a large number of studies are still needed to further clarify the problem.