The Preliminary Effective Evaluation Of Marginal Donor Liver In Orthotopic Liver Transplantation

Objective: Liver transplantation is one of the most effective treatments for end-stage liver disease,liver malignancies,and acute and chronic liver failure.Due to the severe lack of donors,many patients die from disease progression before waiting for a suitable liver,so adding marginal donors is one of the key ways to solve the donor shortage.However,there is still a lot of controversy regarding the use of marginal donor livers.It is planned to explore the efficacy of marginal donor livers in liver transplantation in combination with the actual situation of liver transplantation in this center.Methods: Retrospective analysis of clinical and demographic data of patients and related donors who underwent allogeneic orthotopic liver transplantation at the Organ Transplantation Center of the First Affiliated Hospital of Hunan Normal University from January 2018 to December2019.To collect the demographic data and blood sampling indexes of patients at day,week,January,March,and half a year before and after surgery.(1)Divided into marginal liver group and standard liver group according to different donor sources.The marginal liver group was divided into two groups with risk factors ? 2 and risk factors greater than2 according to different risk factors.According to the MELD-Na score ofthe recipient before surgery,it was divided into two groups: MELD-Na ?15 and MELD> 15 To analyze and compare the recovery of liver function after liver transplantation among different groups.(2)Univariate and multivariate analysis of different types of marginal donor livers,and analysis of possible risk factors for early liver dysfunction after surgery.(3)According to the recovery of liver function on the 7th day after surgery,patients were divided into the group with good liver function recovery and the group with incomplete liver function recovery.Impact of liver function recovery.Results:1.A total of 48 people were included in this study,of which 25 were in the marginal liver group and 23 were in the standard liver group.There were no statistics on the preoperative gender,age,TB,ALT,AST,Cr,and MELD-Na scores of the two groups.difference.There were 18 people with good liver function recovery after liver transplantation and 30 people with liver dysfunction group in the early postoperative period.There was no statistical difference in ALT,AST,INR,Cr,and MELD-Na scores between the two groups of patients before surgery.2.In the marginal liver group and the standard liver group,ALT and AST increased significantly on the 1st day after surgery,and decreased significantly to approximately normal about 1 week after the surgery,and remained at normal levels in January,March,and half a year after thesurgery;TB in the liver group increased 1 day after surgery,continued to decrease 1 week,1 month,3 months,and 6 months after surgery,and decreased to normal values around 1 month after surgery.The standard liver group slightly increased 1 day after surgery,1 week after surgery.It continued to decline in January,March,and half a year,and also fell to normal values around 1 month after operation.The differences in ALT,AST,and TB between the two groups before and after surgery were statistically significant(P <0.05).3.There was a statistically significant difference in the incidence of liver dysfunction in the marginal liver group and the standard liver group in the early one week postoperatively(P <0.05).> 0.05).4.Regardless of the marginal liver group or the standard liver group,there was no significant difference in the incidence of early liver dysfunction in recipients with MELD-Na score ?15 and MELD-Na score> 15(P> 0.05).5.Marginal liver risk factors> The incidence of early liver dysfunction in 2 groups was higher than that in marginal liver risk factors ? 2 groups(Chi-square = 5.218,P = 0.022).6.The single-factor and multi-factor Logistic analysis of the risk factors of marginal donor liver were not statistically significant.Among them,fatty liver,blood type inconsistency with donor liver,elderly liver and preoperative donor liver insufficiency may be early liver function after operation.Incomplete risk factors(OR> 1).Conclusions:1.The incidence of early liver dysfunction in the marginal donor group was higher than that in the standard donor group,but after 1 month,the liver function was not significantly different from that in the standard donor group.2.The preoperative ALT,AST,INR,Cr,and MELD scores have ittle effect on the liver function recovery of the recipients.3.For the comparison of liver donors with different risk factors,donors with more risk factors are more likely to have early liver dysfunction after surgery.4.Fatty liver,blood type inconsistency with donor liver,elderly liver,and preoperative liver dysfunction may be risk factors for postoperative liver dysfunction.5.In the current situation of relatively insufficient donors,the use of marginal liver is relatively safe,and it is safer to select donors with fewer risk factors.