Abstract:

Objective To investigate the effect of cold ischemic time（CIT）on liver transplantation functionin the early stage after orthotopic liver transplantation（OLT）for critical liver disease. Methods From January 1，2015 to June 25，2019，the clinical data of 59 critically ill liver patients undergoing OLT at the Third Medical Center ofChinese PLA General Hospital were collected and analyzed. The clinical data were divided into group A（CIT ≤ 8 h，n ＝ 35），group B（8 h ＜ CIT ≤ 10 h，n ＝ 16），and group C（CIT ＞ 10 h，n ＝ 8）. Blood samples were collected preoperatively and 1，7，14，30，60 d after OLT to detect the dynamic changes of alanine aminotransferase（ALT），aspartate transaminase（AST），prothrombin time international normalized ratio（PT-INR）and prothrombin time activity （PTA）. Results Comparing the levels of ALT and AST in each group at the early postoperative stage，the levels of ALT and AST in all three groups reached the peak on the first day after OLT，and then gradually decreased. Both ALT and AST were equivalent between groups A and B on the 14th day，and the two indices were equivalent among group A，B and C on the 30th day. Correlation analysis demonstrated that the length of CIT was positively correlated with the peak value of ALT on the first day after OLT. Postoperative PT-INR and PTA of recipients in each group were significantly lower thanthose before OLT，and the difference within each independent sample were statistically significant. Conclusion Early recovery of liver function in patients with critical liver disease after OLT was affected by CIT significantly，and the ideal CITwas less than 8 ～ 10 h. 

Key words:

Cold ischemia time, Critical liver disease, Orthotopic liver transplantation, Liver function

摘要：

目的 探讨冷缺血时间（cold ischemic time，CIT）对危重症肝病患者行原位肝移植术（orthotopic liver transplantation，OLT）后移植肝早期功能的影响。 方法 收集并分析 2015 年 1 月 1 日至 2019 年6 月 25 日中国人民解放军总医院第三医学中心 59 例危重症肝病行 OLT 患者的临床资料。按照 CTI 分为 A 组 （CIT ≤ 8 h，n ＝ 35）、B 组（8 h ＜ CIT ≤ 10 h，n ＝ 16）、C 组（CIT ＞ 10 h，n ＝ 8）三组。收集受体术前和 术后 1、7、14、30、60 d 的血液样本，检测丙氨酸转氨酶（alanine aminotransferase，ALT）、天冬氨酸转氨酶（aspartate transaminase，AST）、凝血酶原时间国际标准化比值（prothrombin time international normalized ratio，PT-INR） 和凝血酶原时间活动度（prothrombin time activity，PTA）等指标的变化情况。 结果 各组 ALT、AST 水平 均在术后 1 d 达到峰值，随后逐渐下降，A、B 两组间至 14 d 两项指标无显著性差异，A、B、C 三组间至 30 d 两项指标无显著性差异。相关性分析显示 ：CIT 的长短与肝移植术后第 1 天 ALT 最高峰值大小呈正相关。各组术后 PT-INR 较术前均显著降低，PTA 较术前均显著升高，各个独立样本内部差异均具有统计学意义。 结论 危重症肝病患者肝移植术后早期肝功能恢复受 CIT 的影响，最佳的 CIT 应为 8 ～ 10 h。

关键词:

冷缺血时间 , 危重症肝病 , 原位肝移植术 , 肝功能