Risk factors for recurrence of primary biliary cholangitis after liver transplantation in female patients: A Japanese multicenter retrospective study.
Risk factors for recurrence of primary biliary cholangitis after liver transplantation in female patients: A Japanese multicenter retrospective study.
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DOI：
10.1002/hep4.1037
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发表时间：
2017-07
影响因子：
5.1
通讯作者：
Uemoto S
中科院分区：
文献类型：
--
作者：
Kogiso T;Egawa H;Teramukai S;Taniai M;Hashimoto E;Tokushige K;Sakisaka S;Sakabayashi S;Yamamoto M;Umeshita K;Uemoto S
原发性胆道胆管炎（PBC）主要发生在女性个体中，已报道了尸体供体肝移植（LT）后PBC复发（rPBC）的危险因素。我们在活体肝移植（LDLT）后的女性患者中进行了一项回顾性多中心rPBC研究。共入组了388例接受LDLT治疗终末期PBC的女性患者，并评价了术前和手术因素的影响。在312例LDLT后存活超过1年的患者中评价了术后因素。rPBC定义为肝活检中具有典型组织学表现的肝酶水平异常。58例患者（14.9%）在LT后中位4.6（0.8 - 14.5）年发生rPBC。考克斯风险分析（P < 0.05），年龄越小，（风险比，0.95; 95%置信区间，0.920 - 0.982），手术时间更短（1.00; 0.995 - 0.999），血清免疫球蛋白M水平较高（1.00; 1.001 - 1.002），供体性别不匹配（2.45; 1.268 - 4.736），人白细胞抗原B60（2.56; 1.336 - 4.921）和DR 8（1.98; 1.134 - 3.448），以及环孢素A初始治疗（3.14; 1.602 - 6.138）与rPBC显著相关。在rPBC中，Child-Turcotte-Pugh C级（0.46; 0.274 - 0.775）、终末期肝病模型评分（0.96; 0.914 - 0.998）和更新的马约风险评分（1.02; 1.005 - 1.033）的频率显著较低。移植后类固醇的使用减少，抗代谢药物的使用增加rPBC的频率。结论：LT的时机，受体条件，供体特征和免疫抑制药物可能与LT受体的rPBC相关。（Hepatology Communications 2017;1：394-405）
Primary biliary cholangitis (PBC) is diagnosed mainly in female individuals, and risk factors for PBC recurrence (rPBC) after liver transplantation (LT) from cadaveric donors have been reported. We conducted a retrospective multicenter study of rPBC in female patients after living‐donor LT (LDLT). A total of 388 female patients undergoing LDLT for end‐stage PBC were enrolled, and the effects of preoperative and operative factors were evaluated. Postoperative factors were evaluated in 312 patients who survived for more than 1 year post‐LDLT. rPBC was defined as abnormal hepatic enzyme levels with typical histological findings in liver biopsies. Fifty‐eight patients (14.9%) developed rPBC with a median of 4.6 (0.8‐14.5) years post‐LT. Cox hazard analysis (P < 0.05) showed that younger recipient age (hazard ratio, 0.95; 95% confidence interval, 0.920‐0.982), shorter operative time (1.00; 0.995‐0.999), higher serum immunoglobulin M level (1.00; 1.001‐1.002), donor sex mismatch (2.45; 1.268‐4.736), human leukocyte antigen B60 (2.56; 1.336‐4.921) and DR8 (1.98; 1.134‐3.448), and initial treatment with cyclosporine A (3.14; 1.602‐6.138) were significantly associated with rPBC. The frequencies of Child‐Turcotte‐Pugh class C (0.46; 0.274‐0.775), the model of end‐stage liver disease score (0.96; 0.914‐0.998), and updated Mayo risk score (1.02; 1.005‐1.033) were significantly lower in rPBC. Posttransplantation use of steroids decreased and that of antimetabolites increased the frequency of rPBC. Conclusion: The timing of LT, recipient conditions, donor characteristics, and immunosuppressive medications may be associated with rPBC in LT recipients. (Hepatology Communications 2017;1:394–405)
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影响因子：
4.6
作者：
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通讯作者：
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