Early Diagnosis of Primary Nonfunction and Indication for Reoperation After Liver Transplantation
Early Diagnosis of Primary Nonfunction and Indication for Reoperation After Liver Transplantation
复制标题
DOI：
10.1002/lt.21973
复制
发表时间：
2010-02-01
影响因子：
4.6
通讯作者：
Stockmann, Martin
中科院分区：
文献类型：
--
作者：
Lock, Johan Friso;Schwabauer, Eugen;Stockmann, Martin
早期移植物功能是影响肝移植（LTX）后临床结局的主要因素，但目前还没有一种可靠的方法来评估和预测LTX后移植物功能障碍。在一项前瞻性初步研究中，对99例接受死亡供体LTX的患者进行了研究，以评价LiMAx试验、吲哚菁绿色试验和常规生化参数诊断初始移植物功能障碍的灵敏度和预后能力。患有初始移植物功能障碍（定义为技术并发症或原发性无功能（n = 8））的患者在LTX后即刻的LiMAx读数显著降低（43 +/- 18 vs 184 98 pg/kg/h，P < 0.001）。单因素分析也显示血清胆红素、氨、谷氨酸脱氢酶和国际标准化比值存在显著差异（P < 0.05），但多变量分析显示LiMAx是初始功能障碍的单一独立预测因子受试者工作特征曲线下面积（AUROC）为0.960（95%可信区间= 0.921-0.998，P < 0.001）。此外，在术后第一天，使用UMAX和天冬氨酸转氨酶（AST）活性评价原发性无功能（n = 3）的诊断。计算的AUROC值为0.992（0.975-1.0，P = 0.004），LiMAx和0.967 AST（0.929-1.0，P = 0.006）通过LTX后直接和第一天获得的测试结果的组合，LiMAx指示原发性无功能，灵敏度为1.0（0.31-1.0），阳性预测值为1.0 AST分级的敏感性为0.67（0.13-0.98），阳性预测值为0.29（0.05-0.70）。总之，使用LiMAx试验评估初始移植物功能可能有效识别LTX后24小时内可能威胁移植物存活的严重并发症。肝移植16：172-180，2010。(C)2010年AASLD。
Initial graft function is a major factor influencing the clinical outcome after liver transplantation (LTX), but a reliable method for assessing and predicting graft dysfunction directly after LTX is not available. Ninety-nine patients undergoing deceased-donor LTX were studied in a prospective pilot study to evaluate the LiMAx test, the indocyanine green test, and conventional biochemical parameters with respect to their sensitivity and prognostic power for the diagnosis of initial graft dysfunction. Patients suffering from initial graft dysfunction (defined as technical complications or primary nonfunction (n = 8)) had significantly decreased LiMAx readouts (43 +/- 18 versus 184 98 pg/kg/hour, P < 0.001) immediately after LTX. Univariate analysis also showed significant differences for serum bilirubin, ammonia, glutamate dehydrogenase, and the international normalized ratio (P < 0.05), but multivariate analysis revealed LiMAx as the single independent predictor of initial dysfunction (P = 0.008) with an area under the receiver operating characteristic curve (AUROC) of 0.960 (95% confidence interval = 0.921-0.998, P < 0.001). In addition, the diagnosis of primary nonfunction (n = 3) was evaluated with UMAX and aspartate aminotransferase (AST) activity on the first postoperative day. The calculated AUROC values were 0.992 (0.975-1.0, P = 0.004) for LiMAx and 0.967 (0.929-1.0, P = 0.006) for AST By a combination of test results obtained directly after LTX and on the first day, LiMAx indicated primary nonfunction with a sensitivity of 1.0 (0.31-1.0) and a positive predictive value of 1.0 (0.31-1.0), whereas AST classification showed a sensitivity of 0.67 (0.13-0.98) and a positive predictive value of 0.29 (0.05-0.70). In conclusion, the assessment of initial graft function using the LiMAx test might be effective for identifying critical complications that could threaten graft survival within 24 hours after LTX. Liver Transpl 16:172-180, 2010. (C) 2010 AASLD.