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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2025, Vol. 14 ›› Issue (06) : 894 -901. doi: 10.3877/cma.j.issn.2095-3232.2025.06.013

临床研究

原位肝移植术后即时并发症发生情况及其影响因素分析
闫学丽1,2, 孔德莹2, 胡颖辉2, 向俊西1,†()   
  1. 1　710061　西安交通大学第一附属医院肝胆外科
    2　710061　西安交通大学第一附属医院医疗信息管理办公室
  • 收稿日期:2025-06-18 出版日期:2025-12-10
  • 通信作者: 向俊西
  • 基金资助:
    癌症、心脑血管、呼吸和代谢性疾病防治研究国家科技重大专项(2023ZD0502004); 陕西省创新能力支撑计划(2023KJXX-030)

Incidence and risk factors of immediate complications after orthotopic liver transplantation

Xueli Yan1,2, Deying Kong2, Yinghui Hu2, Junxi Xiang1,†()   

  1. 1 Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
    2 Medical Information Management Office, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
  • Received:2025-06-18 Published:2025-12-10
  • Corresponding author: Junxi Xiang
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引用本文：

闫学丽, 孔德莹, 胡颖辉, 向俊西. 原位肝移植术后即时并发症发生情况及其影响因素分析[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(06): 894-901.

Xueli Yan, Deying Kong, Yinghui Hu, Junxi Xiang. Incidence and risk factors of immediate complications after orthotopic liver transplantation[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(06): 894-901.

目的

探讨原位肝移植术后即时并发症发生情况及其影响因素。

方法

回顾性分析2014年1月至2023年12月在西安交通大学第一附属医院接受同种异体原位肝移植的1 079例患者临床资料。患者和（或）家属签署知情同意书，符合医学伦理学规定。其中男848例，女231例；年龄 6个月~71岁，中位年龄48岁。收集患者住院病历资料和生化指标等，评估术后即时并发症发生率及采用Logistic回归进行术后即时并发症危险因素分析。

结果

肝移植患者术后即时并发症发生率为12.97%（140/1 079），其中前5位分别为术后感染5.65%（61/1 079）、术后出血3.34%（36/1 079）、其他脏器功能衰竭3.24%（35/1 079）、血管并发症1.95%（21/1 079）、移植肝衰竭或免疫排斥1.30%（14/1 079）。术后感染中以肺部感染（36例）和腹腔感染（16例）多见，其他脏器功能衰竭主要以术后肾功能衰竭（25例）为主，血管并发症中移植后肝动脉血栓形成14例，移植后门静脉血栓形成或狭窄4例。患者总体Charlson合并症指数（CCI）评分为（3.1±1.3）分，其中即时并发症组CCI评分为（3.3±1.2）分，明显高于无即时并发症组的（3.0±1.3）分（t=2.16，P<0.05）。Logistic多因素回归分析显示，CCI、TB、INR、入住ICU、非肿瘤性肝脏疾病、酒精性肝硬化是肝移植术后出现即时并发症的独立危险因素（OR=1.428，1.003，1.857，2.243，2.159，2.970；P<0.05）。高CCI组术后感染和术后出血发生率分别为8.13%（23/283）、5.30%（15/283），明显高于低CCI组的4.77%（38/796）、2.64%（21/796）（χ2=4.401，4.588；P<0.05）。

结论

肝移植患者术后即时并发症发生率较高，CCI评分≥4分患者术后感染和出血发生率明显升高。CCI升高、高胆红素、高INR、入住ICU、非肿瘤性肝脏疾病以及酒精性肝硬化是肝移植术后出现即时并发症的独立危险因素。

关键词: 肝移植, 并发症, Charlson合并症指数, 影响因素
Objective

To investigate the incidence and risk factors of immediate complications after orthotopic liver transplantation.

Methods

Clinical data of 1 079 patients undergoing orthotopic liver transplantation in the First Affiliated Hospital of Xi'an Jiaotong University from January 2014 to December 2023 were retrospectively analyzed. The informed consents of all patients and/or family members were obtained and the local ethical committee approval was received. Among them, 848 patients were male and 231 female, aged from 6 months to 71 years, with a median age of 48 years. Medical records and biochemical indexes of all patients were collected. The incidence and risk factors of immediate complications after orthotopic liver transplantation were evaluated. The risk factors of postoperative immediate complications were assessed by Logistic regression analysis.

Results

The incidence of immediate complications after liver transplantation was 12.97%(140/1 079), among which the top five complications were postoperative infection [5.65%(61/1 079)], postoperative bleeding [3.34%(36/1 079)], other organ failure [3.24%(35/1 079)] and vascular complications [1.95%(21/1 079)], liver graft failure or immune rejection [1.30%(14/1 079)], respectively. Pulmonary infection (n=36) and abdominal infection (n=16) were the most common postoperative infections. Other organ failure mainly included postoperative renal failure (n=25). Among vascular complications, there were 14 cases of hepatic artery thrombosis after liver transplantation and 4 cases of portal vein thrombosis or stenosis after liver transplantation. The overall Charlson comorbidity index (CCI) score of all patients was (3.1±1.3). The CCI score of patients with immediate complications was (3.3±1.2), significantly higher than (3.0±1.3) of those without immediate complications (t=2.16, P<0.05). Multivariate Logistic regression analysis showed that CCI, TB, INR, admission to ICU, non-neoplastic liver diseases and alcoholic cirrhosis were the independent risk factors for immediate complications after liver transplantation (OR=1.428, 1.003, 1.857, 2.243, 2.159, 2.970; all P<0.05). The incidence of postoperative infection and bleeding in the high CCI group were 8.13%(23/283) and 5.30%(15/283), significantly higher than 4.77%(38/796) and 2.64%(21/796) in the low CCI group (χ2=4.401, 4.588; both P<0.05).

Conclusions

The incidence of immediate complications after liver transplantation is relatively high. The incidence of postoperative infection and bleeding is remarkably elevated in patients with CCI score of ≥4. Elevated CCI score, high bilirubin, high INR, admission to ICU, non-neoplastic liver diseases and alcoholic cirrhosis are the independent risk factors for immediate complications after liver transplantation.

Key words: Liver transplantation, Complication, Charlson comorbidity index(CCI), Influencing factor
表1 CCI合并症及权重分值
合并症 权重分值(分) 合并症 权重分值(分)
心肌梗死 1 糖尿病 1
充血性心力衰竭 1 糖尿病伴慢性并发症 2
外周血管疾病 1 偏瘫或截瘫 2
脑血管疾病 1 肾病 2
痴呆 1 恶性肿瘤(包括白血病和淋巴瘤) 2
慢性肺病 1 中/重度肝病 3
结缔组织疾病 1 转移性实体瘤 6
消化性溃疡 1 获得性免疫缺陷综合征 6
轻度肝病 1
表2 肝移植术后即时并发症发生情况[例（%）]
术后并发症 疾病编码 发生率
术后感染 K65.9/D73.3/B25/A41/T81.4/K83.0/U07/J98.414/J94.8/J15/J18/B49/B00/N39.0/J86 61（5.65）
术后出血 T81.0/K66.1/R58/K92.2 36（3.34）
其他脏器功能衰竭 J96/J80/R65.3/R68.800x001/N19.x03/N17.9/I50.9/I51.800x004/R57.9 35（3.24）
血管并发症 I74/I80/I81/T86.400x009/T86.400x003 21（1.95）
移植肝功能衰竭或免疫排斥 T86.001/T86.400/T86.400x006/T86.400x017/T86.401/K72.0/K72.9 14（1.30）
脑血管并发症 I61/I62/I63 6（0.56）
消化道瘘或狭窄 K91.807/K86.810/K27.504/K63.207/K91.822 8（0.74）
伤口愈合延迟 T81.400x004/T81.300x001 2（0.19）
其他 K65.806/D69.6/D65/D68/I49/E87/D70 13（1.20）
表3 术后即时并发症组和无即时并发症组临床资料比较
参数 即时并发症组 无即时并发症组 统计值 P值
年龄(岁,
±s)		 48±10 48±10 t=0.234 0.815
性别(男/女) 107/33 741/198 χ2=0.447 0.504
腹部手术史[例 (%)] 31(22.1) 227(24.2) χ2=0.276 0.599
MELD/PELD评分(分,
±s)		 20±9 15±6 t=7.623 <0.001
儿童肝移植[例(%)] 1(0.7) 4(0.4) - 0.502
移植术式(例, a/b/c) 135/4/1 931/8/0 - 0.008
CCI评分(分,
±s)		 3.3±1.2 3.0±1.3 t=2.160 0.031
肝恶性肿瘤[例(%)] 36(34.6) 339(36.1) χ2=5.798 0.016
肝硬化类型(例, 1/2/3/4/5/6/7/8) 83/13/2/12/2/2/1/25 606/85/56/25/18/12/12/125 χ2=19.911 0.006
入住ICU[例(%)] 103(73.6) 481(51.2) χ2=24.503 <0.001
术后住院时间[d, M(QR)] 28(40) 18(9) Z=6.804 <0.001
总住院时间[d, M(QR)] 31(41) 18(9) Z=6.925 <0.001
住院总费用[万元, M(QR)] 52(38) 40(116) Z=8.370 <0.001
抗菌药物费用[万元, M(QR)] 3.2(4.9) 1.1(1.5) Z=7.517 <0.001
表4 肝移植术后即时并发症影响因素Logistic回归分析
参数 单因素 多因素
OR 95%CI P值 OR 95%CI P值
CCI 1.157 1.013~1.322 0.031 1.428 1.001~2.038 0.049
aCCI 1.145 1.028~1.275 0.013 1.066 0.815~1.393 0.640
TB 1.004 1.003~1.005 <0.001 1.003 1.001~1.005 0.002
Scr 1.005 1.001~1.008 0.021 0.999 0.994~1.005 0.847
INR 2.265 1.754~2.923 <0.001 1.857 1.119~3.081 0.017
MELD/PELD评分 1.092 1.065~1.119 <0.001 0.984 0.914~1.060 0.677
入住ICU 2.651 1.782~3.942 <0.001 2.243 1.418~3.548 <0.001
术后住院时间 1.066 1.052~1.080 <0.001 1.046 0.997~1.096 0.064
住院时间 1.062 1.049~1.076 <0.001 1.022 0.978~1.069 0.333
腹部手术史 0.892 0.583~1.319 0.504
非肿瘤性肝脏疾病 1.632 1.092~2.439 0.017 2.159 1.198~3.889 0.010
儿童肝移植 1.682 0.187~15.155 0.643
非经典原位肝移植 4.310 1.390~13.367 0.011 3.732 0.864~16.126 0.078
丙肝肝硬化 0.229 0.055~0.946 0.042 0.418 0.094~1.860 0.252
酒精性肝硬化 3.427 1.681~6.991 <0.001 2.970 1.174~7.518 0.022
表5 不同CCI分组术后并发症比较[例（%）]
组别 例数 术后感染 术后出血 移植肝功能衰竭或免疫排斥 其他脏器功能衰竭 血管并发症
低CCI组 796 38(4.77) 21(2.64) 9(1.13) 21(2.64) 16(2.01)
高CCI组 283 23(8.13) 15(5.30) 5(1.77) 14(4.95) 5(1.77)
χ2值 4.401 4.588 0.660 3.547 0.065
P值 0.036 0.032 0.417 0.06 0.799
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