Donor Hepatic Occult Collagen Deposition Predisposes to Peritransplant Stress and Impacts Human Liver Transplantation.
Donor Hepatic Occult Collagen Deposition Predisposes to Peritransplant Stress and Impacts Human Liver Transplantation.
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DOI：
10.1002/hep.32030
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发表时间：
2021-11
期刊：
影响因子：
13.5
通讯作者：
Kaldas, Fady M.
中科院分区：
文献类型：
--
作者：
Hirao, Hirofumi;Ito, Takahiro;Kadono, Kentaro;Kojima, Hidenobu;Naini, Bita, V;Nakamura, Kojiro;Kageyama, Shoichi;Busuttil, Ronald W.;Kupiec-Weglinski, Jerzy W.;Kaldas, Fady M.
环境引发的慢性肝脏炎症会导致胶原沉积，而没有任何特定症状的早期纤维化很难被检测到。我们推测，临床肝移植(LT)中的一些人供体移植物可能存在无法识别的纤维化，影响它们对LT诱导的应激和肝细胞损伤的易感性。这项回顾性研究旨在评估隐匿性肝纤维化对临床肝移植结果的影响。用天狼星红对194例人供肝活检标本进行胶原染色，并测量阳性面积(天狼星红阳性面积；SRA)。用962例供者在采购时的数据计算体重指数、天冬氨酸转氨酶/丙氨酸氨基转移酶比值、糖尿病评分。根据SRA和BARD评分分析移植结果，包括缺血再灌注损伤(IRI)、移植肾早期功能障碍(EAD)和存活率。移植物SRA中位数为9.4%，分为低SRA组(15%；n=140)和高SRA组(≥，15%；n=54)。与低SRA组相比，高SRA组移植物的IRI和EAD发生率更高(P<0.05)。有趣的是，高SRA被确认为EAD的独立危险因素，并与供者BARD评分呈正相关。同期比较低BARD组(n=692)和高BARD组(n=270)，高BARD组肝移植后转氨酶水平明显升高，IRI和EAD发生率也较高。这些发现来自迄今为止最大的临床研究队列，证明了供体肝脏中隐匿性胶原沉积对肝移植结果的重要作用。高SRA和供体BARD评分与肝移植受者肝脏IRI和EAD的发生率增加相关。这项研究为深入和前瞻性评估隐匿性纤维化提供了理论基础，以便进行精细化的个性化肝移植治疗。
Environmentally triggered chronic liver inflammation can cause collagen deposits, whereas early stages of fibrosis without any specific symptoms could hardly be detectable. We hypothesized that some of the human donor grafts in clinical liver transplantation (LT) might possess unrecognizable fibrosis, affecting their susceptibility to LT‐induced stress and hepatocellular damage. This retrospective study aimed to assess the impact of occult hepatic fibrosis on clinical LT outcomes. Human (194) donor liver biopsies were stained for collagen with Sirius red, and positive areas (Sirius red–positive area; SRA) were measured. The body mass index, aspartate aminotransferase/alanine aminotransferase ratio, diabetes score was calculated using 962 cases of the donor data at the procurement. LT outcomes, including ischemia‐reperfusion injury (IRI), early allograft dysfunction (EAD), and survival rates, were analyzed according to SRA and BARD scores. With the median SRA in 194 grafts of 9.4%, grafts were classified into low‐SRA (<15%; n = 140) and high‐SRA (≥15%; n = 54) groups. Grafts with high SRA suffered from higher rates of IRI and EAD (P < 0.05) as compared to those with low SRA. Interestingly, high SRA was identified as an independent risk factor for EAD and positively correlated with the donor BARD score. When comparing low‐BARD (n = 692) with high‐BARD (n = 270) grafts in the same period, those with high BARD showed significantly higher post‐LT transaminase levels and higher rates of IRI and EAD. These findings from the largest clinical study cohort to date document the essential role of occult collagen deposition in donor livers on LT outcomes. High‐SRA and donor BARD scores correlated with an increased incidence of hepatic IRI and EAD in LT recipients. This study provides the rationale for in‐depth and prospective assessment of occult fibrosis for refined personalized LT management.
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影响因子：
25.7
作者：
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