Ischemia-reperfusion injury and its relationship with early allograft dysfunction in liver transplant patients
Ischemia-reperfusion injury and its relationship with early allograft dysfunction in liver transplant patients
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DOI：
10.1111/ajt.16219
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发表时间：
2020-09-10
影响因子：
8.8
通讯作者：
Kaldas, Fady M.
中科院分区：
文献类型：
--
作者：
Ito, Takahiro;Naini, Bita V.;Kaldas, Fady M.
缺血再灌注损伤(IRI)被认为是肝移植(LT)后移植物功能障碍的原因之一。然而，关于IRI和移植物早期功能障碍(EAD)在IRI移植物中的影响的研究有限。对接受肝移植的506例移植血管进行了组织学IRI分级，并根据IRI的严重程度(无、轻度、轻度、中度和重度)进行分类。在506支移植物中，87.4%发生IRI(无：12.6%，轻度：38.1%，轻度：35.4%，中度：13.0%，重度：0.8%)。IRI的严重程度与EAD的发生率和移植物6个月的存活率相关。较长的冷/热缺血时间、受体/供体高血压和有男性供体是中度到重度IRI的独立危险因素。在70个中到重度IRI的移植物中，42.9%的移植物发生了EAD，与没有EAD的移植物相比，有EAD的移植物的存活率显著降低。较长的冷缺血时间和大液滴大泡状脂肪变性(>；=20%)是EAD的独立危险因素。我们的研究表明，IRI严重程度的增加与较差的短期移植结果相关。在供受者配型过程中仔细考虑IRI危险因素可能有助于优化移植物利用率和移植结局。此外，识别IRI相关性EAD的危险因素可以指导患者的治疗和可能的及时移植物替换。
Ischemia-reperfusion injury (IRI) is believed to contribute to graft dysfunction after liver transplantation (LT). However, studies on IRI and the impact of early allograft dysfunction (EAD) in IRI grafts are limited. Histological IRI was graded in 506 grafts from patients who had undergone LT and classified based on IRI severity (no, minimal, mild, moderate, and severe). Of the 506 grafts, 87.4% had IRI (no: 12.6%, minimal: 38.1%, mild: 35.4%, moderate: 13.0%, and severe: 0.8%). IRI severity correlated with the incidence of EAD and graft survival at 6 months. Longer cold/warm ischemia time, recipient/donor hypertension, and having a male donor were identified as independent risk factors for moderate to severe IRI. Among 70 grafts with moderate to severe IRI, 42.9% of grafts developed EAD, and grafts with EAD had significantly inferior survival compared to grafts without EAD. Longer cold ischemia time and large droplet macrovesicular steatosis (>= 20%) were identified as independent risk factors for EAD. Our study demonstrated that increased IRI severity was correlated with inferior short-term graft outcomes. Careful consideration of IRI risk factors during donor-recipient matching may assist in optimizing graft utilization and LT outcomes. Furthermore, identification of risk factors of IRI-associated EAD may guide patient management and possible timely graft replacement.