Impact Of Graft To Body Weight Ratio On Early Post-transplant Systemic Inflammatory Response Syndrome In Pediatric Liver Transplantation

Objective systemic inflammatory response syndrome(SIRS)has both infectious and non-infectious factors.infection is a common cause of hospitalization death after liver transplantation,and non-infectious factors can’t be ignored.It’s important to eliminate the possible risk factors of SIRS and to intervene promptly before transplantation.The purpose of this study was to analyze the influencing factors and outcomes of early SIRS in children after liver transplantation,to explore the mechanism of GRWR induced SIRS.Methods a retrospective analysis of July 2017 to November 2019,73 cases of pediatric liver transplantation patients in the first affiliated hospital of guangxi medical university,according to the 2 weeks after liver transplantation presence and absence SIRS,divided into early post-transplant systemic inflammatory response syndrome group(SIRS group)and no early post-transplant systemic inflammatory response syndrome group(non-SIRS group).Clinical data from Pre-transplant,intraoperative and Post-transplant factor of the two groups were compared at baseline.The multivariate logistic regression analysis investigate the independent risk factors of early post-transplant SIRS,to calculate the cutoff according to receiver operating characteristics(ROC)curve as the same time.Results 39 cases [53.4%,95%CI(41.7%-65.1%)] of 73 cases in patients occurred early post-transplant SIRS.In SIRS group,GRWR was greater(3.68±1.21 vs.3.05±1.04%),P=0.020),red cells concentrates transfusion to body weight ratio was higher(RCWR)[60.0(39.6,75.6)vs.39.6(25.2,72.0)ml/kg;P=0.049],and Mechanical ventilation time(MVT)after transplantation was longer [63.6(35.0,105.3)vs.38.5(15.0,65.0)h;P=0.039]compared with the non-SIRS group.The cumulative survival rate of SIRS group was significantly lower than non-SIRS group(84.6% vs.100%;P = 0.018).ROC curve analysis showed that GRWR=3.08% [area under the curve(AUC)=0.672;P=0.008],with sensitivity of 82.1% and specificity of 52.9%.Multivariate analysis determined that GRWR>3.08% [OR=3.65,95%CI(1.05-12.66),P=0.042] as the independent risk factor for early post-transplant SIRS.Conclusion The survival of early SIRS in children after liver transplantation was poor,and the occurrence of early post-transplant SIRS was associated with GRWR.GRWR>3.08% predicts that SIRS has certain sensitivity early post-transplant.In order to achieve a better transplant effect,the appropriate ratio of GRWR was selected to fully evaluate the grafts of the patients,especially in patients with high risk factors before transplantation.