Analysis Of Clinical Characteristics Of The Dead Recipients And Clinical Study On Influencing Factors Of Severe Cardiovascular Events During Perioperative Period After Adult Liver Transplantation

Liver transplantation has become one of the most effective methods for the treatment of end-stage liver disease.with the development of surgical technology and the application of new immunosuppressants,the survival rate after liver transplantation is increasing,but there are still many critically ill patients with poor prognosis.in addition,end-stage liver disease can lead to a series of pathophysiological changes in the cardiovascular system,so it is not uncommon for liver transplant recipients to have serious cardiovascular events during the perioperative period.This paper systematically summarizes the clinical data of adult liver transplant recipients in our center,analyzes the causes and characteristics of death,and preliminarily discusses the influencing factors of perioperative serious cardiovascular events.to provide some help and reference for clinical prevention and treatment measures to improve the survival rate of liver transplantation patients.Part Ⅰ Analysis of clinical characteristics of dead recipients after adult liver transplantation.Objective:To investigate the clinical characteristics of the dead recipients after adult liver transplantation(LT),and to provide reference for improving the prognosis of adult LT recipients.Methods:The clinical data of 145 dead adult LT patients who underwent surgery in Organ Transplantation Center of the Affiliated Hospital of Qingdao University from January2016 to December 2020 were retrospectively analyzed.Results:Among the 145 dead recipients of adult liver transplantation,23 patients died within30 days after operation,of which 7 cases died of infection complications(4.82%)and 5cases died of cardiovascular events(3.45%).16 patients died in 31-90 d after operation,Among them,8 cases died of infection complications(5.51%),106 cases died more than 90 days after operation,and 88 cases died of recurrence of liver cancer(60.69%).In this study,98 patients with hepatocellular carcinoma had a median survival time of 492.0(279.0-727.0)days.There was a significant difference in survival time among the three groups(χ~ 2 = 8.861,P < 0.05).Compared with Milan standard and Hangzhou super-Milan group,super-Hangzhou standard group had significantly shortened median survival time,the difference was statistically significant(χ~2=17.246、16.912,P<0.05).Conclusion : The main causes of early and middle stage death after adult liver transplantation was infectious complications,followed by cardiovascular events,while the main cause of late death after liver transplantation was recurrence of liver cancer.Regular follow-up treatment,active prevention and treatment of infectious complications,cardiovascular events,recurrence of liver cancer and other complications will help to improve the survival rate after adult liver transplantation.Part Ⅱ Clinical study on influencing factors of severe cardiovascular events during perioperative period of adult liver transplantation Objective:To investigate the influencing factors and prognosis analysis of severe cardiovascular events during perioperative period of adult liver transplantation.Methods:The clinical data of 545 patients who underwent adult liver transplantation in the affiliated Hospital of Qingdao University from January 2016 to December 2020 were retrospectively analyzed.According to the occurrence of severe cardiovascular events(Major Adverse Cardiovascular Events,MACE)during the perioperative period of liver transplantation,the patients were divided into two groups: MACE group and no MACE group.The influencing factors and prognosis of MACE were analyzed.Results:In 545 cases of adult liver transplantation,perioperative MACE occurred in 57 cases,MACE did not occur in 488 cases,and the incidence of MACE was 10.4%.Age,MELD score,preoperative hypertension,heart disease,hepatic encephalopathy history,intraoperative anhepatic period,bleeding volume,erythrocyte infusion volume,postoperative mechanical ventilation time and ICU time,total bilirubin level 1-7 days after operation,and creatinine level 4-7 days after operation were the influencing factors of MACE in perioperative period of liver transplantation.Multivariate analysis showed that age,MELD score,history of hypertension and lactic acid level within 5 minutes after opening were independent risk factors for MACE.The cumulative survival rates of 1month,3 months,6 months and 12 months after operation in the group without non-MACE were 96.1%,93.2%,89.8% and 84.4%,respectively,and the overall survival rates in the MACE group were 84.2%,77.2%,73.7% and 68.4%,respectively,and the difference was statistically significant.(P<0.001).Conclusion:Age,MELD score,history of hypertension and lactate level within 5 minutes after opening were independent risk factors for perioperative MACE after liver transplantation.The prognosis of patients with MACE was significantly worse than that of patients without MACE.Accurate evaluation and early intervention before operation,individualized operation plan and anesthesia management,and standardized treatment plan for the occurrence of MACE after operation are important means to reduce the incidence and mortality of perioperative MACE after liver transplantation.