Analyse The Risk Factors Of Biliary Complications After DCD Orthotopic Liver Transplantation In Adult Patients

Background:Since the first case of orthotopic liver transplantation has been implemented successfully by the American organ transplantation expert Starzl in 1963,meanwhile, thanks to the discoveries and perfections of anti-rejection drugs, organ preservation solution, transplant techniques and materials, narcotic drugs and techniques, the past 50 years have witnessed a rapid development in liver transplantation.In China,the trial of human liver transplantation was carried out in 1977. With the increase of the number of operations and the improvement of technologies, the long-term survival rate of patients with liver transplantation was significantly increased. At present, the success rate of many liver transplantation centers is more than 90%, and 5-year-survival rate is more than 70% in our country,the transplantation effect has been in line with the international advanced level. As a passive choice at the beginning to become an active treatment gradually, liver transplantation has become the only effective way to treat end-stage liver disease.However,with the continuous development of liver transplantation’s technology, various complications(rejection, vascular complications and biliary complications) has been highlighted, which affect rehabilitation and postoperative quality of life seriously with liver transplantation. Biliary complications(anastomotic biliary strictures, biliary leak, non-anastomotic biliary strictures, biliary stones, biliary infection,biliary bleeding) as the first complications after liver transplantation, the physical and psychological impact on patients after surgery is particularly prominent.It mainly shows in the high incidence of biliary complications and serious consequences after liver transplation,the result is serious.According to the statistics, the incidence is between 10% to 40%, and 6% ~ 13% of them need to receive a liver transplant again, the fatality rate reaches up to 19%. Biliary complications are one of the most important reasons for long-term survival and the loss of graft,which called "Achilles heel" by liver transplantation pioneer Sir Roy Calne.Therefore, to prevent and control biliary complications after liver transplantation have attracted great attention of the global transplant experts,how to improve the survival rate and patients’ living quality, and reduce the occurrence of biliary complications after liver transplantation are the focuses of clinical and basic research,which is the key to increase the survival rate and further curative effect in transplant recipients.For this reason, how to reduce the incidence of postoperative biliary complications has become a difficult and urgent task in front of us. Objective:In view of the diversity and complexity of the influencing factors of biliary complications after liver transplantation,in oder to control the morbidity of BC and improve the prognosis of liver transplantation,we investigate the risk factors, through a retrospective review of liver transplantation in the First Hospital of Jilin University by statistical principle and method. Research Methods:Collect the First Hospital of Jilin university liver transplantation center from September 14, 2011 to February 7, 2015 of the 67 cases of cardiac death donor liver transplant clinical data(receptor for age, sex, cold ischemia time, HBV infection situation and ABO blood group is incompatible or not, the cause of death of donor, warm ischemia time, child-Pugh score, meld score,, operation time, intraoperative blood loss).Analysis of the above parameters in two groups of contrast analysis and find the influence of biliary complications after liver transplantation.Using SPSS 20.0 statistical software to analyze data.Measurement data are first Kolmogorov- Smirnov normality test, accord with normal distribution by using two independent sample t-test, does not conform to the sample with two independent Wilcoxon rank and inspection.Comparison between count data set using chi-square chi-square test, does not meet the chi-square spear inspection conditions with Fisher’s exact probability.For the difference was statistically significant P <0.05.Then all the positive indicators were included in the binary logistic regression analysis to find out the main risk factors. Test levelα= 0.05. Research Results :67 patients were performed DCD in orthotopic liver transplantation(OLT), 2 cases died within one day after liver transplantation was excluded. There are 13 patients with biliary complications, the incidence was 20.00%. 13 cases of biliary strictures,Which combined biliary infection in 2 cases, biliary stones in 1 case,biliary leak in 1 case, anastomotic biliary strictures in 2 cases,non-anastomotic biliary strictures in 7 case. Conclusions:Cold ischemic time, warm ischemia time is the independent risk factors of BC.Comparing with males,females have a higher occurrence of BC.Operation time were not independent risk factors, but closely related to the occurrence of BC. Receptors with hepatitis B virus, recipient age,ABO blood group incompatibility, Child-Pugh score, Meld score, the cause of death and intraoperative blood loss is not an important factor in the incidence of BC after transplantation.