Analysis of Ischemia/Reperfusion Injury in Time-Zero Biopsies Predicts Liver Allograft Outcomes
Analysis of Ischemia/Reperfusion Injury in Time-Zero Biopsies Predicts Liver Allograft Outcomes
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DOI：
10.1002/lt.24072
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发表时间：
2015-04-01
影响因子：
4.6
通讯作者：
Pettigrew, Gavin J.
中科院分区：
文献类型：
--
作者：
Ali, Jason M.;Davies, Susan E.;Pettigrew, Gavin J.
肝移植后发生的缺血/再灌注损伤（IRI）可能影响移植物的长期存活，但目前对其了解甚少。在这里，我们将移植物血运重建后零时活检样本的组织学分级确定的IRI严重程度与患者和移植物结局相关联。2000年至2010年期间在我们中心进行的476例肝移植的零时活检分级如下：无（10.5%），轻度（58.8%），中度（26.1%）和重度（4.6%）。严重IRI与供体年龄、循环死亡后的供体、冷缺血时间延长和肝脏脂肪变性有关，但也与原发性无功能（9.1%）和90天内再次移植（22.7%）的发生率增加有关。严重IRI组的长期结果也很差，1年移植物和患者存活率分别仅为55%和68%（参见90%，其余为93%）。在多变量分析中，零时活检时的严重IRI是1年移植物存活率的独立决定因素，并且是1年移植物丢失的更好预测因子，优于肝脂肪变性、早期移植物功能障碍综合征和第一周高丙氨酸氨基转移酶，阳性预测值为45%。零时活检可预测肝移植后不良的临床结果，而活检时出现严重的IRI则提示可能需要早期再次移植。肝移植21：487-499，2015。(c)2015年AASLD。
Ischemia/reperfusion injury (IRI) that develops after liver implantation may prejudice long-term graft survival, but it remains poorly understood. Here we correlate the severity of IRIs that were determined by histological grading of time-zero biopsies sampled after graft revascularization with patient and graft outcomes. Time-zero biopsies of 476 liver transplants performed at our center between 2000 and 2010 were graded as follows: nil (10.5%), mild (58.8%), moderate (26.1%), and severe (4.6%). Severe IRI was associated with donor age, donation after circulatory death, prolonged cold ischemia time, and liver steatosis, but it was also associated with increased rates of primary nonfunction (9.1%) and retransplantation within 90 days (22.7%). Longer term outcomes in the severe IRI group were also poor, with 1-year graft and patient survival rates of only 55% and 68%, respectively (cf. 90% and 93% for the remainder). Severe IRI on the time-zero biopsy was, in a multivariate analysis, an independent determinant of 1-year graft survival and was a better predictor of 1-year graft loss than liver steatosis, early graft dysfunction syndrome, and high first-week alanine aminotransferase with a positive predictive value of 45%. Time-zero biopsies predict adverse clinical outcomes after liver transplantation, and severe IRI upon biopsy signals the likely need for early retransplantation. Liver Transpl 21:487-499, 2015. (c) 2015 AASLD.