The Impact Of Donor Vasopressor Support On Liver Transplant Recipients In Donor After Cardiac Death

Objective:Clinical materials of DCD liver transplant donors and recipients were retrospectively analyzed, to explore the impact of donor vasopressor support on DCD liver transplant recipients, which contains early graft function and related complications. The study will provide reference to Clinical practice for liver transplantation.Method:73 cases of DCD liver transplantation admitted in the First Hospital of Jilin University during July 2013 and January 2016 were collected retrospectively.Donor information: age, sex, height, weight, BMI(body mass index), cause of death, ICU admission, vasopressor using, laboratory indicators before donation(AST,ALT, TB, CR, ALB, Serum sodium). Graft information: degree of liver steatosis, cold ischemia time, and warm ischemia time. Operation information: operation time, blood loss. Recipient information: age, sex, disease, MELD score, laboratory indicators before transplant(AST, ALT, TB, PT, INR, CR), postoperative laboratory indicators(AST, ALT, TB, PT, INR CR), the occurrence of postoperative complications(contains PEGF and PNF).73 cases were divided into 3 groups(large-dose group, small-dose group, no-using group),based on whether vasopressors were given to donor.Statistical analysis was carried out with SPSS Statistics 23.0, Continuous variables were tested for normal distribution using the Kolmogorov- Smirnov test. To compare quantitative data of both groups, one-way ANOVA was applied when possible(normal distribution),otherwise a Mann-Whitney test for two independent samples would have beenutilized. Chi-square test for qualitative data. All calculations were regarded as significance at a p-value of <0.05.Results:1.Vasopressor using. During the maintenance before donation, 15 cases from the total did not use vasopressor, 58 cases used vasopressor. Vasopressor contains Dopamine drugs combined with norepinephrine or not. High-dose group contains 33 cases, low-dose group were 25 cases2.Comparison for Liver function index after liver transplantation. Comparing AST and ALT on the right postoperative day, differences among the 3 groups was statistically significant, p value is 0.001, 0.007, respectively.3. Comparison for incidence rate of PEGF and PNF. 1 cases from all was diagnosed as primary liver function(PNF), died on the 7th postoperative day, this case belongs to high-dose treatment group. 22 Of 73 cases meet poor early graft function(PEGF), accounting for 30.1%.Large-dose group was 48.5%, small-dose group is 20.0%, no-using group was 6.7%,, difference among 3 groups was statistically significant(P = 0.005).Conclusion:1、DCD donors using large-dose vasopressor drugs have to face worse liver function index, high incidence of PEGF, and possible PNF after liver transplant. The choices for these donor livers should consider carefully.2、DCD donors using small-dose vasopressor drugs were similar with no-using group in liver function index, incidence of PEGF after liver transplant. The choices for these donor livers should be safer.