【原】吸入麻醉药对肝移植患者早期临床结局的影响

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Impact of Volatile Anesthetic Agents on Early Clinical Outcomes in Liver Transplantation

背景与目的

很少有研究报道吸入麻醉药对肝移植术后缺血再灌注损伤（IRI）中的影响。本研究拟对2001和2015之间所有肝移植（LT）器官受者和器官捐赠者的数据进行单中心回顾性分析，比较吸入性麻醉药对早期肝移植患者IRI的影响。

方  法

对2001和2015之间所有LT器官受者和器官捐赠者的数据进行单中心回顾性分析。基础麻醉药是由麻醉医师自行决定的。在术后每天对血清丙氨酸转氨酶（ALT）和总胆红素（TB）水平进行测量以作为评估早期移植损伤和功能恢复的措施。记录存活率和临床结局。

结  果

本研究共纳入1291例LT患者，3中主要吸入麻醉药：异氟醚（62%）、地氟醚（8%）和七氟醚（30%）。在移植后第7天，ALT峰值在地氟醚组最低（352），其次是七氟醚组（411）和异氟烷组（481）（P＝.09）。移植后第7天各组ALT和TB水平相似。移植存活率各组在1、7、30d统计学相似，1年内各组患者移植存活率相当。

结  论

3种药物移植早期发生肝功能异常和肾功能异常的率相同。高危供体移植物的亚组分析差异无统计学意义。综上所述，地氟醚或七氟醚可以对IRI后肝功能的早期保护有一定作用，但其长期结局和其他吸入麻醉药相当。

原始文献摘要

Mangus RS1, Kinsella SB2, Farar DT2, Fridell JA3, Woolf LT2, Kubal CA3.

Impact of Volatile Anesthetic Agents on Early Clinical Outcomes in Liver Transplantation.

Transplant Proc. 2018 Jun;50(5):1372-1377. doi: 10.1016/j.transproceed.2018.03.001.

ABSTRACT

Background：Few studies have assessed the ability of inhaled anesthetic agents to

ameliorate ischemia-reperfusion injury (IRI) in liver transplantation (LT). This study

compares inhaled anesthetics in early liver allograft IRI. LT recipient and organ donor

data were extracted retrospectively for all LTs at a single center between 2001 and 2015.

Methods：LT recipient and organ donor data were extracted retrospectively for all LTs at a single center between 2001 and 2015. The choice of primary anesthetic agent was at the discretion of the anesthesiologist. Serum alanine aminotransferase (ALT) and total bilirubin (TB) levels were measured daily in the post-transplant period as measures of early graft injury and function. Survival and clinical outcomes are reported.

Results：There were 1291 primary LTs included in the analysis, with 3 primary inhaled agents: isoflurane (62%), desflurane (8%), and sevoflurane (30%). In the first 7 days posttransplant, the peak ALT level was lowest for desflurane (352), followed by sevoflurane (411) and isoflurane (481) (P =.09). All groups had similar ALT and TB by 7 days post-transplant. Graft survival for all 3 groups was statistically similar at 1, 7, and 30 days, with equivalent patient and graft survival at 1 year.

Conclusions： All 3 agents had similar rates of early allograft dysfunction and renal

dysfunction. Subgroup analysis of high-risk donor grafts showed no statistical difference. In conclusion, administration of desflurane or sevoflurane may provide some early hepatoprotection against IRI, but longer-term outcomes were equivalent for all agents.

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