■铁过载在慢性肝病患者中很常见,与遗传性血色素沉着病患者肝移植后生存期缩短有关。其对无遗传性血色素沉着症患者的影响尚不清楚。该研究的目的是研究在学术三级转诊中心接受肝移植的患者中铁过载的临床影响。
■我们进行了一项回顾性队列研究,包括2015年至2017年在墨西哥城的学术三级转诊中心接受肝移植的所有无遗传性血色素沉着病的患者。对外植体肝活检进行再处理以获得组织化学肝铁指数,考虑分数≥0.15为铁过载。比较有无铁超负荷的患者的基线特征。使用Kaplan-Meier方法估计生存率,与对数秩检验和Cox比例风险模型进行比较。
■包括105名患者,45%有铁过载。病毒和代谢病因,酒精消费,铁超负荷患者的肥胖发生率高于无铁超负荷患者(43%vs.21%,32%vs.22%,p=0.011;34%vs.9%,p=0.001;32%vs.12%,分别为p=0.013)。8例患者在肝移植后90天内死亡(1例铁超负荷)。铁过载患者的并发症发生率高于无铁过载患者(223vs.93个事件/100个人月;出现任何并发症的中位时间为2次。3天,p=0.043),并发症类型无差异。铁过载患者的死亡率低于无铁过载患者(0.7vs.4.5死亡/100人-月,p=0.055)。
■检测铁超负荷可能确定肝移植术后有早期并发症风险的患者。需要进一步的研究来了解铁过载在生存中的作用。
Iron overload is frequent in patients with chronic liver disease, associated with shorter survival after liver transplantation in patients with hereditary hemochromatosis. Its effect on patients without hereditary hemochromatosis is unclear. The aim of the study was to study the clinical impact of iron overload in patients who underwent liver transplantation at an academic tertiary referral center.
We performed a retrospective cohort study including all patients without hereditary hemochromatosis who underwent liver transplantation from 2015 to 2017 at an academic tertiary referral center in Mexico City. Explant liver biopsies were reprocessed to obtain the histochemical hepatic iron index, considering a score ≥ 0.15 as iron overload. Baseline characteristics were compared between patients with and without iron overload. Survival was estimated using the Kaplan-Meier method, compared with the log-rank test and the Cox proportional hazards model.
Of 105 patients included, 45% had iron overload. Viral and metabolic etiologies, alcohol consumption, and obesity were more frequent in patients with iron overload than in those without iron overload (43% vs. 21%, 32% vs. 22%, p = 0.011; 34% vs. 9%, p = 0.001; and 32% vs. 12%, p = 0.013, respectively). Eight patients died within 90 days after liver transplantation (one with iron overload). Complication rate was higher in patients with iron overload versus those without iron overload (223 vs. 93 events/100 personmonths; median time to any complication of 2 vs. 3 days, p = 0.043), without differences in complication type. Fatality rate was lower in patients with iron overload versus those without iron overload (0.7 vs. 4.5 deaths/100 person-months, p = 0.055).
Detecting iron overload might identify patients at risk of early complications after liver transplantation. Further studies are required to understand the role of iron overload in survival.