背景:最近有报道称供体γ-谷氨酰转移酶(GGT)峰值在器官获取时对肝移植(LT)预后不良风险的潜在有害作用越来越感兴趣。然而,关于这一主题的文献很少,关于证明这种相关性的机制存在有争议的数据。这项研究旨在证明供体GGT在大型欧洲LT队列中对移植后90天移植物丢失的不利影响。
方法:这是一项回顾性国际研究,调查了2004年1月至2018年9月在四个欧洲合作中心接受首次LT的1335名成年患者。
结果:构建了两个不同的多变量逻辑回归模型来评估移植后90天移植物丢失的危险因素,引入供体GGT作为连续或二分变量。在这两种模型中,供体GGT显示出作为移植物损失预测因子的独立作用。详细来说,对数转换的连续供体GGT值显示比值比为1.46(95%CI=1.03-2.07;p=0.03).当使用160IU/L的截止值对供体GGT峰值进行二分时,比值比为1.90(95%CI=1.20-3.02;p=0.006).当移植物损失率被调查时,供体GGT≥160IU/L的LT病例报告的发生率明显更高。详细来说,90天移植物损失率为23.2%。13.9%的患者与高低供体GGT,分别(对数秩p=0.004)。捐赠者GGT也被添加到常规用于预测结果的分数中(即,MELD,D-MELD,DRI,和BAR得分)。在所有情况下,当评分与捐赠者GGT相结合时,观察到模型精度的提高。
结论:供体GGT可能是评估移植移植物质量的有价值的标志物。供体GGT应在旨在预测移植后临床结果的评分中实施。应更好地阐明GGT和不良LT结局相关的确切机制,并需要针对该主题的前瞻性研究。
BACKGROUND: Growing interest has been recently reported in the potential detrimental role of donor gamma-glutamyl transferase (GGT) peak at the time of organ procurement regarding the risk of poor outcomes after liver transplantation (LT). However, the literature on this topic is scarce and controversial data exist on the mechanisms justifying such a correlation. This study aims to demonstrate the adverse effect of donor GGT in a large European LT cohort regarding 90-day post-transplant graft loss.
METHODS: This is a retrospective international study investigating 1335 adult patients receiving a first LT from January 2004 to September 2018 in four collaborative European centers.
RESULTS: Two different multivariable logistic regression models were constructed to evaluate the risk factors for 90-day post-transplant graft loss, introducing donor GGT as a continuous or dichotomous variable. In both models, donor GGT showed an independent role as a predictor of graft loss. In detail, the log-transformed continuous donor GGT value showed an odds ratio of 1.46 (95% CI = 1.03-2.07; p = 0.03). When the donor GGT peak value was dichotomized using a cut-off of 160 IU/L, the odds ratio was 1.90 (95% CI = 1.20-3.02; p = 0.006). When the graft-loss rates were investigated, significantly higher rates were reported in LT cases with donor GGT ≥160 IU/L. In detail, 90-day graft-loss rates were 23.2% vs. 13.9% in patients with high vs. low donor GGT, respectively (log-rank p = 0.004). Donor GGT was also added to scores conventionally used to predict outcomes (i.e., MELD, D-MELD, DRI, and BAR scores). In all cases, when the score was combined with the donor GGT, an improvement in the model accuracy was observed.
CONCLUSIONS: Donor GGT could represent a valuable marker for evaluating graft quality at transplantation. Donor GGT should be implemented in scores aimed at predicting post-transplant clinical outcomes. The exact mechanisms correlating GGT and poor LT outcomes should be better clarified and need prospective studies focused on this topic.