Abstract：
The liver-gut axis has been identified as crucial mediator of liver regeneration. Thus, the use of a T-tube in liver transplantation (LT), which interrupts the enterohepatic bile circulation, may potentially have a detrimental effect on the early allograft functional recovery. We retrospectively analyzed a cohort of 261 patients transplanted with a whole liver graft, with a duct-to-duct biliary anastomosis, who did not develop any surgical complication within postoperative day 14. Early allograft dysfunction (EAD) was defined according to the criteria of Olthoff et al. (EAD-O), and graded according to the Model for Early Allograft Function (MEAF) score. EAD-O developed in 24.7% of recipients and the median MEAF score was 4.0 [interquartile range 2.9-5.5]. Both MEAF and EAD predicted 90-day post-LT mortality. A T-tube was used in 49.4% of cases (n = 129). After a propensity score matching for donor age, cold and warm ischemia time, donor risk index, balance of risk score, Child-Pugh class C, and MELD score, the T-tube group showed a significantly higher prevalence of EAD-O and value of MEAF than the no-T-tube group (EAD-O: 29 [34.1%] vs 16 [19.0%], p = 0.027; MEAF 4.5 [3.5-5.7] vs 3.7 [2.9-5.0], p = 0.014). In conclusion, T-tube use in LT may be a risk factor for EAD and higher MEAF, irrespective of graft quality and severity of pre-LT liver disease.
摘要：
肝-肠轴已被确定为肝再生的关键介质。因此，T型管在肝移植中的应用，阻断肝肠胆汁循环,可能对早期同种异体移植功能恢复产生不利影响。我们回顾性分析了261例患者的全肝脏移植，胆管到胆管吻合，术后第14天未出现任何手术并发症。根据Olthoff等人的标准定义早期同种异体移植功能障碍（EAD）。(EAD-O),并根据早期同种异体移植功能模型(MEAF)评分进行分级。24.7％的接受者出现EAD-O，MEAF评分中位数为4.0[四分位距2.9-5.5]。MEAF和EAD都预测了LT后90天的死亡率。在49.4%的病例中使用了T型管(n=129)。在与捐赠者年龄相匹配的倾向评分之后，冷和热缺血时间，捐赠者风险指数，风险评分的平衡，Child-PughC级,和MELD得分，T管组EAD-O的患病率和MEAF的值明显高于无T管组（EAD-O：29[34.1％]vs16[19.0％]，p=0.027；MEAF4.5[3.5-5.7]对3.7[2.9-5.0]，p=0.014)。总之,在LT中使用T管可能是EAD和较高MEAF的危险因素，无论移植物质量和LT前肝病的严重程度。
