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Abstract：
BACKGROUND: The utilization of liver transplantation (LT) is limited by the availability of suitable organs. This study aimed to assess the impact of the donor risk index (DRI) and other donor characteristics on fibrosis progression, graft, and patient survival in hepatitis C virus (HCV)-infected LT recipients.
METHODS: HCV-infected LT recipients who had at least 2 post-LT protocol liver biopsy specimens available were included. Hazard ratio for bivariate analysis was computed using Cox proportional hazard regression analysis.
RESULTS: Of 312 recipients, 26.6% died over a median follow-up of 58.5 months (95% CI: 46.5-67.3). Fourteen patients underwent re-transplantation. Mean time to graft failure was 84.3 months, median follow-up: 59 months, 95% CI (48.2, 68.3). DRI >1.5 was significantly associated with patient and graft survival (P = 0.04). Of the subset of 104 individuals who underwent histological analysis, 67.3% progressed to ≥F2. On multivariate analysis, significant donor-specific predictors of fibrosis progression were: donor age >50 years and DRI >1.7.
CONCLUSIONS: (1) Fibrosis progression in HCV-infected LT recipients is strongly associated with donor characteristics, specifically donor age and DRI. (2) DRI, an objective measure of donor quality, appears to correlate both with rate of histological progression and overall patient/graft survival.
METHODS: HCV-infected LT recipients who had at least 2 post-LT protocol liver biopsy specimens available were included. Hazard ratio for bivariate analysis was computed using Cox proportional hazard regression analysis.
RESULTS: Of 312 recipients, 26.6% died over a median follow-up of 58.5 months (95% CI: 46.5-67.3). Fourteen patients underwent re-transplantation. Mean time to graft failure was 84.3 months, median follow-up: 59 months, 95% CI (48.2, 68.3). DRI >1.5 was significantly associated with patient and graft survival (P = 0.04). Of the subset of 104 individuals who underwent histological analysis, 67.3% progressed to ≥F2. On multivariate analysis, significant donor-specific predictors of fibrosis progression were: donor age >50 years and DRI >1.7.
CONCLUSIONS: (1) Fibrosis progression in HCV-infected LT recipients is strongly associated with donor characteristics, specifically donor age and DRI. (2) DRI, an objective measure of donor quality, appears to correlate both with rate of histological progression and overall patient/graft survival.
摘要：
背景：肝移植（LT）的利用受到合适器官的可用性的限制。本研究旨在评估供体风险指数（DRI）和其他供体特征对纤维化进展的影响。移植,和丙型肝炎病毒（HCV）感染的LT受者的患者生存率。
方法：纳入至少2例LT方案后肝活检标本的HCV感染LT受者。使用Cox比例风险回归分析计算双变量分析的风险比。
结果：在312个收件人中，26.6%的患者在58.5个月的中位随访时间内死亡（95%CI：46.5-67.3）。14例患者接受了再次移植。平均移植失败时间为84.3个月，中位随访时间：59个月，95%CI（48.2，68.3）。DRI>1.5与患者和移植物存活显著相关(P=0.04)。在104例接受组织学分析的个体中，67.3%进展到≥F2。在多变量分析中，纤维化进展的重要供体特异性预测因子为:供体年龄>50岁,DRI>1.7.
结论：(1)HCV感染LT受体的纤维化进展与供体特征密切相关，特别是供体年龄和DRI。(2)DRI,对捐赠者质量的客观衡量，似乎与组织学进展率和总体患者/移植物存活率均相关。
方法：纳入至少2例LT方案后肝活检标本的HCV感染LT受者。使用Cox比例风险回归分析计算双变量分析的风险比。
结果：在312个收件人中，26.6%的患者在58.5个月的中位随访时间内死亡（95%CI：46.5-67.3）。14例患者接受了再次移植。平均移植失败时间为84.3个月，中位随访时间：59个月，95%CI（48.2，68.3）。DRI>1.5与患者和移植物存活显著相关(P=0.04)。在104例接受组织学分析的个体中，67.3%进展到≥F2。在多变量分析中，纤维化进展的重要供体特异性预测因子为:供体年龄>50岁,DRI>1.7.
结论：(1)HCV感染LT受体的纤维化进展与供体特征密切相关，特别是供体年龄和DRI。(2)DRI,对捐赠者质量的客观衡量，似乎与组织学进展率和总体患者/移植物存活率均相关。
