■灌注后肝活检(PRB)可以评估原位肝移植(OLT)后缺血/再灌注损伤(IRI)的程度。IRI对移植物结局和总体生存率的影响存在争议。
■为了确定PRB中IRI的严重程度与总体移植物和患者生存率之间的相关性,其次,确定预测移植物结局不良的PRB因素。
■这是对所有使用脑死亡后捐赠(DBD)与PRB进行OLT的患者的回顾性分析。对PRB中IRI的严重程度进行分级。使用单变量和多变量分析以及Kaplan-Meier对移植物和总体生存率进行对数秩检验来评估IRI的预测因子。分别。
■我们包括280个OLT(64.7%)。IRI严重程度的组织病理学评估如下:无IRI(N=96,34.3%),轻度IRI(N=65;23.2%),中等IRI(N=101;36.1%),和严重的IRI(N=18;6.4%)。初始良好移植物功能(IGGF)的发生率,原发性无功能和早期同种异体移植功能障碍(EAD)占32.5%,3.9%,和18.6%,分别。严重IRI与IGGF发生率较低相关(OR:0.34,95%CI0.12-0.92;P=0.03)。严重IRI患者的EAD发生率较高(33.2%vs.18.6,P=0.23)。在多因素分析中,冷缺血时间是严重IRI的独立预测因子。严重的IRI与低的1年和5年总生存率相关(67%和44%,分别,与非重度IRI的84%和68%相比)。患有严重IRI的患者表现出较差的移植物和总体生存率。
■冷缺血时间预测严重IRI的发展。患有严重IRI的患者显示出更差的移植物和总体存活率以及更低的IGGF发生率。提示组织病理学发现可用于识别OLT术后预后较差的高危患者.
UNASSIGNED: Postreperfusion liver biopsy (PRB) can assess the degree of ischemia/reperfusion injury (IRI) after orthotopic liver transplantation (OLT). The influence of IRI on graft outcomes and overall survival is controversial.
UNASSIGNED: To determine the correlation between the severity of IRI in PRB and overall graft and patient survival and, secondarily, to identify factors on PRB that predict poor graft outcomes.
UNASSIGNED: This is a retrospective analysis of all patients who underwent OLT using donation after brain death (DBD) with PRB. The severity of IRI in PRB was graded. Predictors of IRI were assessed using univariate and multivariate analysis and the Kaplan-Meier with log rank test for the graft and overall survival, respectively.
UNASSIGNED: We included 280 OLTs (64.7%). The histopathological assessment of IRI severity was as follows: no IRI (N = 96, 34.3%), mild IRI (N = 65; 23.2%), moderate IRI (N = 101; 36.1%), and severe IRI (N = 18; 6.4%). The incidence rates of initial good graft function (IGGF), primary nonfunction and early allograft dysfunction (EAD) were 32.5%, 3.9%, and 18.6%, respectively. Severe IRI was associated with a lower incidence of IGGF (OR: 0.34, 95% CI 0.12-0.92; P = 0.03). Patients with severe IRI tended to have a higher incidence of EAD (33.2% vs. 18.6, P = 0.23). The cold ischemia time was an independent predictor of severe IRI on the multivariate analysis. Severe IRI was associated with poor 1- and 5-year overall survival rates (67% and 44%, respectively, compared with 84 and 68% in nonsevere IRI). Patients with severe IRI exhibited worse graft and overall survival.
UNASSIGNED: Cold ischemia time predicts the development of severe IRI. Patients with severe IRI show worse graft and overall survival and a lower incidence of IGGF, suggesting that histopathological findings could be useful for identifying patients at high risk of worse outcomes after OLT.