Grade of deceased donor liver macrovesicular steatosis impacts graft and recipient outcomes more than the Donor Risk Index
Grade of deceased donor liver macrovesicular steatosis impacts graft and recipient outcomes more than the Donor Risk Index
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DOI：
10.1111/j.1440-1746.2011.06844.x
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发表时间：
2012-03-01
影响因子：
4.1
通讯作者：
Verran, Deborah J.
中科院分区：
文献类型：
--
作者：
de Graaf, Esther L.;Kench, James;Verran, Deborah J.
背景和目的：供肝脂肪变性可影响肝移植结局。本研究的目的是全面报告供体脂肪变性的类型和级别的影响，以及捐助者和受体的因素，包括报告的供体风险指数（DRI），对肝移植outcome.Methods：回顾单位数据的所有成人肝移植手术从2001年至2007年，以及捐助者提供。结果：255例肝活检标本中有184例（72%）发现脂肪变性，其中114例（62%）为微泡性脂肪变性（MiS：68例轻度，22例中度，24例重度），70例（38%）为大泡性脂肪变性（MaS：59例轻度，7例中度，4例重度）。大多数（66/70，94%）MaS活检也包含MiS。同种异体移植物脂肪变性与供体体重指数增加有关（P = 0.000），且供体性别为男性（P < 0.05）。原发性肾功能不全（P = 0.002）、早期肾功能衰竭（P = 0.040）和需要再次移植（P = 0.012）仅与重度MaS相关。早期胆道并发症与中度MaS相关（P = 0.039）。只有重度MaS与3个月（相对危险度= 12.09 [8.75-19.05]，P = 0.000）和1年（P = 0.000）时的移植物生存率差显著相关。结论：MiS是一种常见的发现，在肝移植物活检中经常与MaS共存，而孤立的MaS则不常见。只有中度至重度MaS的存在与较差的早期同种异体移植物结局相关。严重MaS对同种异体移植物存活率的影响似乎大于其他供体因素，包括计算的DRI。
Background and Aim: Donor liver steatosis can impact on liver allograft outcomes. The aim of the present study was to comprehensively report on the impact of type and grade of donor steatosis, as well as donor and recipient factors, including the reported Donor Risk Index (DRI), on liver allograft outcomes.Methods: Areview of unit data for all adult liver transplant procedures from 2001 to 2007, as well as donor offers. Donor liver biopsies were regraded for steatosis by an experienced histopathologist.Results: Steatosis was detected in 184/255 (72%) of biopsies, of which 114 (62%) had microvesicular steatosis (MiS; 68 mild, 22 moderate, 24 severe) and 70 (38%) macrovesicular steatosis (MaS; 59 mild, 7 moderate, 4 severe). The majority (66/70, 94%) of biopsies with MaS also contained MiS. Allograft steatosis was associated with increasing donor body mass index (P = 0.000), plus donor male sex (P < 0.05). Primary non function (P = 0.002), early renal failure (P = 0.040), and requirement for retransplantation (P = 0.012) were associated only with severe MaS. Early biliary complications were associated with moderate MaS (P = 0.039). Only severe MaS was significantly associated with inferior allograft survival at 3 months (relative risk = 12.09 [8.75-19.05], P = 0.000) and 1 year (P = 0.000).Conclusions: MiS is a common finding and frequently coexists with MaS on liver allograft biopsy, while isolated MaS is uncommon. Only the presence of moderate to severe MaS is associated with inferior early allograft outcomes. The impact of severe MaS on allograft survival appears greater than other donor factors, including the calculated DRI.