大量血浆交换增加abo血型不相容活体肝移植中细菌感染的风险。

IF 5.3 2区医学 Q1 IMMUNOLOGY Transplantation Pub Date : 2024-08-01 Epub Date: 2023-12-07 DOI:10.1097/TP.0000000000004883

Mun Chae Choi, Eun-Ki Min, Seung Hyuk Yim, Deok-Gie Kim, Jae Geun Lee, Dong Jin Joo, Myoung Soo Kim

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引用次数: 0

摘要

背景:细菌感染是导致活体肝移植(LDLT)死亡率和发病率的主要并发症。在脱敏方案的abo不相容(ABOi)受者中，细菌感染的风险与血浆交换(PEs)数量的关系尚未进行研究。因此，我们的目的是分析高PEs的ABOi LDLT受者与低PEs受者的细菌感染风险。方法:对681名成年LDLT受者进行回顾性研究，其中171名ABOi LDLT受者根据6次PE的临界值被分为高(n = 52)和低(n = 119) PE组。我们将肝移植后6个月内的细菌感染和术后菌血症与abo相容(ABOc) LDLT组(n = 510)作为对照组进行比较。结果:高PE组细菌感染率为49.9%，术后菌血症率为28.8%，明显高于低PE组(31.1%，17.8%)和ABOc组(26.7%，18.0%)。在多因素分析中，高PE组的细菌感染风险高出2.4倍(P = 0.008)。该组5年生存率为58.6%，低于其他2组(81.5%和78.5%;P = 0.030和0.001)。结论:高术前PEs增加了ABOi LDLT患者的细菌感染率和术后菌血症。

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High Number of Plasma Exchanges Increases the Risk of Bacterial Infection in ABO-incompatible Living Donor Liver Transplantation.

Background: Bacterial infections are major complications that cause significant mortality and morbidity in living donor liver transplantation (LDLT). The risk of bacterial infection has not been studied in ABO-incompatible (ABOi) recipients with a desensitization protocol in relation to the number of plasma exchanges (PEs). Therefore, we aimed to analyze the risk of bacterial infection in ABOi LDLT recipients with a high number of PEs compared with recipients with a low number of PEs.

Methods: A retrospective study was performed with 681 adult LDLT recipients, of whom 171 ABOi LDLT recipients were categorized into the high (n = 52) or low (n = 119) PE groups based on a cutoff value of 6 PE sessions. We compared bacterial infections and postoperative bacteremia within 6 mo after liver transplantation with the ABO-compatible (ABOc) LDLT group (n = 510) as a control group.

Results: The high PE group showed a bacterial infection rate of 49.9% and a postoperative bacteremia rate of 28.8%, which were significantly higher than those of the low PE group (31.1%, 17.8%) and the ABOc group (26.7%, 18.0%). In multivariate analysis, the high PE group was found to have a 2.4-fold higher risk of bacterial infection ( P = 0.008). This group presented a lower 5-y survival rate of 58.6% compared with the other 2 groups (81.5% and 78.5%; P = 0.030 and 0.001).

Conclusions: A high number of preoperative PEs increases bacterial infection rate and postoperative bacteremia in ABOi LDLT.

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来源期刊

Transplantation 医学-免疫学

CiteScore

8.50

自引率

11.30%

发文量

1906

审稿时长

1 months

期刊介绍： The official journal of The Transplantation Society, and the International Liver Transplantation Society, Transplantation is published monthly and is the most cited and influential journal in the field, with more than 25,000 citations per year. Transplantation has been the trusted source for extensive and timely coverage of the most important advances in transplantation for over 50 years. The Editors and Editorial Board are an international group of research and clinical leaders that includes many pioneers of the field, representing a diverse range of areas of expertise. This capable editorial team provides thoughtful and thorough peer review, and delivers rapid, careful and insightful editorial evaluation of all manuscripts submitted to the journal. Transplantation is committed to rapid review and publication. The journal remains competitive with a time to first decision of fewer than 21 days. Transplantation was the first in the field to offer CME credit to its peer reviewers for reviews completed. The journal publishes original research articles in original clinical science and original basic science. Short reports bring attention to research at the forefront of the field. Other areas covered include cell therapy and islet transplantation, immunobiology and genomics, and xenotransplantation.