Risk factors of severe intrahepatic cholestasis during early period after liver transplantation

• DOI: 10.3760/cma.j.issn.1673-9752.2012.06.011
• Publication Date: 2012-12-20
• Authors: Sheng Zhang; Jie Zhou; Yong-fa Tan; Kai T; Liyan Chen
• Keywords: Prothrombin time; Cryoprecipitate

Objective To investigate the risk factors of severe intrahepatic cholestasis during early period after liver transplantation.Methods The clinical data 225 patients who received orthotopic transplantation at Nanfang Hospital Southern Medical University from August 2004 to February 2011 were retrospectively analyzed.All divided into positive group (60 with cholestasis) and negative (165 without cholestasis).Preoperative,intraoperative postoperative 2 groups compared via t test,chi-square test,Wilcoxon test or Logistic regression analysis.Results proportion hepatic cirrhosis,hepatic encephalopathy integral,ascites integral,international normalized ratio,and levels prothrombin time (PT),total bilirubin (TBil),aspartate aminotransferase before operation significantly higher than those in (x2 =6.09,Z =2.22,2.60,2.46,2.84,4.81,3.42,P ＜ 0.05),while albumin,Na +,K +,hemoglobin,platelet (PLT) (t =2.10,4.97,Z =2.49,t =3.51,Z =3.66,P 0.05).The ratio compatible blood type donors recipients,ratio fatty graft,cold ischemia time,relative warm time,intraoperative loss,intraoperative transfusion red cells,PLT,and cryoprecipitate =4.29,13.11,Z =2.45,2.61,3.75,3.20,2.89,3.95,P ＜0.05).The incidences acute rejection,hepatic artery embolism,pulmonary infection,bacteraemia,fungal infection cytomegalovirus (CMV) =9.87,4.91,8.21,6.29,3.92,9.26,P results multivariate analysis revealed that preoperative level TBil ＞ 51.3 μmol/L,fatty graft,intraoperative cryoprecipitate,postoperative embolism,postoperative pulmonary infection,bacteraemia,CMV independent inrahepatic (OR =15.82,7.99,2.88,3.03,53.20,3.34,4.11,3.22,P incidence was lower PLT longer PT =0.33,0.25,P mortality rates 6 months 41.7％ (25/60) 19.4％ (32/165),and rate =11.54,P 0.05).Conclusion Correction poor status transplantation,reinforcement control anti-rejection may reduce complications decrease associated mortality.

Key words: Liver transplantation; Intrahepatic cholestasis; Risk