The Effect Of Donor Score Of DCD Liver Transplantation On Early Postoperative Prognosis

Background: Liver transplantation is the only effective treatment for end-stage liver disease,Liver transplantation in China started late.Although it experienced ups and downs, but in the past 20 years, it has developed rapidly.In terms of the number of transplant and surgical techniques have reached the international advanced level.Due to the limitation of traditional culture and laws, Chinese people have not yet fully accepted the legislation of brain death.Our transplant experts established a unique set of standards of death in line with China’s national conditions with Chinese characteristics:Chinese standard,which greatly promote the development of liver transplantation in China.Because of large population base and a large number of people infect hepatitis B, the need for liver transplant patients are far beyond the number of organ donation. The contradiction between supply and demand is serious.In 2015,the prohibition of death row inmates for liver transplantation,which is highly recognized internationally,made the current situation of the organ shortage more serious.How to solve the shortage of donor liver is a severe challenge that our country and the world must face.Some scholars found that there was no significant difference in the survival rate and the incidence of postoperative complications between the recipients who did not strictly follow the existing donor liver selection criteria and strictly follow the donor selection criteria.The application of marginal donors became a popular research.There are some single centries research marginal livers with single factor.But it has not yet formed a unified expansion of the donor selection criteria.With the development of science and technology and the accumulation of experience,the marginal liver is expected to become the effective way to expand the donor pool.Objective: Through the retrospective analysis of the Jilin University transplant center on 61 cases of DCD liver transplantation donor’s clinical data from 2012-02-09 to 2015-08-31,we select the factors that may influence the quality of the donor liver and the complications after operation of the receptor to understand the application of marginal donors and the early prognosis of the receptor. With comprehensive evaluation of risk factors of donor and receptor,we hope to establish a total integral using statistical methods to predict the short-term prognosis of receptor,and to expand the donor pool to solve the contradiction between supply and demand.We strive to make full use of the donor liver.Research Methods: We collect clinical data of 61 patients with DCD liver transplantation performed at the liver transplantation center of No.1 Hospital of Jilin University from 2011-02-09 to 2015-08-31.The datas include the age of the donor, warm ischemia time, cold ischemia time, ratio of fatty liver, serum albumin, total bilirubin, serum sodium, ICU length of stay, MELD score of receptor, ALT and AST data of the two hours,first day, third day,seventh day after the operation,postoperative complications and mortality of receptor, and so on. we collected the donor data at the last time before entering the operation room.According to the recovery of liver function in 1 weeks after operation, the patients were divided into three groups,PNF group,initial poor graft function group and better function group,respectively.KMO and Bartlett test,factor analysis,total score calculation,variance analysis,SNK test and Logistic regression analysis were performed using SPSS 20 statistical software.Research Results: OLT was performed in all 61 patients.7 patients died within 3 months after transplantation.The causes of death included 3 cases of primary liver transplantation(PNF), 1 case of graft versus host disease, 1 case of intraoperative bleeding, 1 case of abdominal hemorrhage and 1 case of cerebral hemorrhage.There are 36 cases of IPGF and 22 cases of better liver function.Kmo=0.647>0.5, Bartlett of the spherical degree test p=0.000 less than 0.05, so the 9 indicators can do factor analysis, a total of 5 common factors are extracted, the total variance of the contribution rate is 72.634%. The difference between the 3 groups is significant for P=0.004,getting from single factor analysis of variance.t We can get that every two groups in the three groups have significant difference in the total score through Student-Newman-Keulsa,b test.The higher the total score, the worse the prognosis effect and the greater the possibility of occurrence of PNF.We can conclude that the higher the donor age, the longer the cold ischemia time, the worse the liver function after operation through the Logistic regression analysis.By means of the component score coefficient matrix, the 5 common factor scores can be calculated. According to the total score whether in the 95% confidence interval of a group can predict the early postoperative prognosis of the receptor.Conclusions: 1、Donor age and cold ischemia time are the influencing factors of the early stage of the recipient, the higher the donor age, the longer the cold ischemia time, the worse the recovery of liver function after operation. 2、 If the total score is in-0.304-0.027,the receptor can get a better liver function,we can use the donor liver safely in clinical;If the total score is in 0.028-0.267,the possibility of IPGF is large,the application of donor liver should be carefully considered in clinical;If the total score is in-0.129-1.212,he possibility of PNF is large,To ensure safety the donor liver should be avoided.