The impact of postreperfusion syndrome during liver transplantation using livers with significant macrosteatosis
The impact of postreperfusion syndrome during liver transplantation using livers with significant macrosteatosis
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DOI：
10.1111/ajt.15330
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发表时间：
2019-09-01
影响因子：
8.8
通讯作者：
Taner, C. Burcin
中科院分区：
文献类型：
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作者：
Croome, Kristopher P.;Lee, David D.;Taner, C. Burcin
使用具有显着大脂肪变性的供体肝脏进行肝移植（LT）期间，再灌注后综合征（PRS）的影响在很大程度上尚不清楚。将2000年至2017年间所有接受具有中度大脂肪变性（30%-60%）供肝的LT（N = 96）的患者的临床结果与接受倾向评分匹配的接受轻度大脂肪变性供肝（10%-29%）（N = 96）和无脂肪变性（N = 96）供肝LT的患者队列进行比较。中度大脂肪变性组中有 8 名 (8.3%) 患者出现再灌注时心脏骤停，而轻度大脂肪变性组中有 1 名 (1.0%) 患者 (P = .02)，无脂肪变性组有 0 名 (0%) 患者 (P = .004)。中度大脂肪变性组患者的 PRS 发生率较高（37.5% vs 18.8%；P = .004）、早期同种异体移植物功能障碍（EAD）（76.4% vs 25.8%；P < .001）、移植后需要连续肾脏替代治疗的肾功能障碍（18.8% vs 8.3%；P = .03）以及 30 天内返回手术室（24.0% vs 7.3%；P = .002)，高于无脂肪变性组。将中度大脂肪变性组与轻度大脂肪变性组和无脂肪变性组进行比较时，长期患者（P = .30 和 P = .08）和移植物存活率（P = .15 和 P = .12）均无统计学意义。使用患有中度大脂肪变性肝脏的 LT 接受者患 PRS 的风险显着增加。如果患者能够克服使用这些供体肝脏最初增加的围手术期风险，则长期移植物存活率似乎与接受无脂肪变性移植物的匹配受者没有什么不同。
The impact of postreperfusion syndrome (PRS) during liver transplantation (LT) using donor livers with significant macrosteatosis is largely unknown. Clinical outcomes of all patients undergoing LT with donor livers with moderate macrosteatosis (30%-60%) (N = 96) between 2000 and 2017 were compared to propensity score matched cohorts of patients undergoing LT with donor livers with mild macrosteatosis (10%-29%) (N = 96) and no steatosis (N = 96). Cardiac arrest at the time of reperfusion was seen in eight (8.3%) of the patients in the moderate macrosteatosis group compared to one (1.0%) of the patients in the mild macrosteatosis group (P = .02) and zero (0%) of the patients in the no steatosis group (P = .004). Patients in the moderate macrosteatosis group had a higher rate of PRS (37.5% vs 18.8%; P = .004), early allograft dysfunction (EAD) (76.4% vs 25.8%; P < .001), renal dysfunction requiring continuous renal replacement therapy following transplant (18.8% vs 8.3%; P = .03) and return to the OR within 30 days (24.0% vs 7.3%; P = .002), than the no steatosis group. Both long-term patient (P = .30 and P = .08) and graft survival (P = .15 and P = .12) were not statistically when comparing the moderate macrosteatosis group to the mild macrosteatosis and no steatosis groups. Recipients of LT using livers with moderate macrosteatosis are at a significant increased risk of PRS. If patients are able to overcome the initial increased perioperative risk of using these donor livers, long-term graft survival does not appear to be different than matched recipients receiving grafts with no steatosis.