期刊
LIVER TRANSPLANTATION
卷 21, 期 4, 页码 487-499出版社
WILEY
DOI: 10.1002/lt.24072
关键词
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资金
- National Institute of Health Research Cambridge Biomedical Research Centre
- Clinical Research Training Fellowship from Wellcome Trust
- Raymond and Beverly Sackler Scholarship
- Engineering and Physical Sciences Research Council [EP/J017213/1]
- Engineering and Physical Sciences Research Council [EP/J017213/1] Funding Source: researchfish
- EPSRC [EP/J017213/1] Funding Source: UKRI
Ischemia/reperfusion injury (IRI) that develops after liver implantation may prejudice long-term graft survival, but it remains poorly understood. Here we correlate the severity of IRIs that were determined by histological grading of time-zero biopsies sampled after graft revascularization with patient and graft outcomes. Time-zero biopsies of 476 liver transplants performed at our center between 2000 and 2010 were graded as follows: nil (10.5%), mild (58.8%), moderate (26.1%), and severe (4.6%). Severe IRI was associated with donor age, donation after circulatory death, prolonged cold ischemia time, and liver steatosis, but it was also associated with increased rates of primary nonfunction (9.1%) and retransplantation within 90 days (22.7%). Longer term outcomes in the severe IRI group were also poor, with 1-year graft and patient survival rates of only 55% and 68%, respectively (cf. 90% and 93% for the remainder). Severe IRI on the time-zero biopsy was, in a multivariate analysis, an independent determinant of 1-year graft survival and was a better predictor of 1-year graft loss than liver steatosis, early graft dysfunction syndrome, and high first-week alanine aminotransferase with a positive predictive value of 45%. Time-zero biopsies predict adverse clinical outcomes after liver transplantation, and severe IRI upon biopsy signals the likely need for early retransplantation. Liver Transpl 21:487-499, 2015. (c) 2015 AASLD.
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