术前 DLCO 可预测肝移植术后严重的早期并发症

IF 2.2 4区医学 Q3 RESPIRATORY SYSTEM Respiratory Medicine and Research Pub Date : 2024-02-07 DOI:10.1016/j.resmer.2024.101089

Xing Li , Louise Barbier , Martine Ferrandière , Francis Remerand , Ephrem Salamé , Laurent Plantier

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引用次数: 0

摘要

背景严重的早期并发症在肝移植（LT）术后很常见，是决定LT相关发病率和死亡率的关键因素。材料与方法回顾性纳入了2015年10月至2020年5月期间在一个中心接受LT手术的轻中度肝病患者（肝病终末期模型-MELD评分≤30分）。主要终点是LT术后严重早期并发症的发生情况，定义为机械通气持续时间> 2天或ICU住院时间> 7天或LT术后1个月再次插管或死亡< 。40名患者（33%）在LT术后出现早期并发症。在LT术后出现严重早期并发症的患者中，一氧化碳的血红蛋白校正肺转移容量（DLCOc）的测量值和预测值均显著降低。通过多变量分析，DLCOc是唯一与严重早期并发症独立相关的变量。DLCOc低于16.3 ml.min-1.mmHg-1可预测呼吸系统并发症，敏感性为67.5%，特异性为62.9%。DLCOc%pred 低于 61.5 % 的敏感性为 56.8 %，特异性为 72 %。DLCOc与用力肺活量（FVC）、肺气肿和肌肉质量指数独立相关。

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Preoperative DLCO predicts severe early complications after liver transplantation

Background

Severe early complications are common after liver transplantation (LT) and are a key determinant of LT-related morbidity and mortality. The aim of this study was to assess whether lung function measured in the pre-operative period predicted complicated outcomes in the first month after LT.

Material and methods

Patients with mild-to-moderate liver disease (Model for End stage Liver Disease-MELD score≤30) who underwent LT between October 2015 and May 2020 in a single centre were retrospectively included. The primary endpoint was the occurrence of severe early complications after LT defined by mechanical ventilation duration > 2 days or length of ICU stay > 7 days or reintubation or death < 1 month after LT.

Results

One hundred and twenty patients were included (age 59 [53–64] years, 72 % men). Forty patients (33 %) had early complications after LT. Measured and%predicted hemoglobin-corrected lung transfer capacity for carbon monoxide (DLCOc) were significantly lower in patients with severe early complications after LT. DLCOc was the only variable that associated independently with severe early complications by multivariate analysis. DLCOc under 16.3 ml.min⁻¹.mmHg⁻¹ predicted respiratory complications with a sensitivity of 67.5 % and a specificity of 62.9 %. DLCOc%pred under 61.5 % had a sensitivity of 56.8 % and a specificity of 72 %. DLCOc independently associated with forced vital capacity (FVC), pulmonary emphysema, and the muscle mass index.