Caglieris S, Giannini E, Dardano G, Mondello L, Valente U, Testa R
Department of Internal Medicine, University of Genoa, Italy.
Hepatogastroenterology. 2000 Jul-Aug;47(34):1045-7.
BACKGROUND/AIMS: The lack of organ availability and an increased number of end-stage cirrhotic patients has led to the lengthening of liver transplantation waiting lists. The progressive worsening of clinical and functional performance in patients awaiting the graft is one of the factors implicated in the increased mortality during the wait and in poor transplantation outcome. In this work our aim was to evaluate the effects of tauroursodeoxycholic acid administration on biochemical, clinical and functional parameters in a group of cirrhotic patients consecutively placed onto our liver transplantation waiting list.
Ten cirrhotic patients underwent biochemical, clinical and functional evaluation at the time of entering on our liver transplantation waiting list, then tauroursodeoxycholic acid was administered until liver transplantation. Complete evaluation was repeated every 2 months. The results were compared to those of a comparable historical control group that had undergone liver transplantation the year before the study.
All patients were transplanted within 6 months from insertion on the waiting list. Longitudinal analysis of the treated group showed that cholestasis and cytolisis parameters constantly decreased and that gamma-glutamyl transpeptidase was significantly lower compared to baseline values at the 4th month of therapy. Clinical and functional parameters remained stable during follow-up. Comparison with the control group showed that gamma-glutamyl transpeptidase, alkaline phosphatase and both aminotransferases were reduced at the 4th month of therapy. Fewer days of hospital stay and less intensive care were required in the treated group.
Treatment of end-stage cirrhotic patients awaiting liver transplantation with tauroursodeoxycholic acid improves biochemical parameters of cytolisis and cholestasis, and furthermore helps to maintain clinical and functional stability during the wait. Improved biochemical conditions and steady clinical-functional performance may promote better short-term transplant outcome.
背景/目的：器官供体短缺以及终末期肝硬化患者数量的增加导致肝移植等待名单延长。等待移植患者临床和功能状况的逐渐恶化是等待期间死亡率增加以及移植效果不佳的因素之一。在本研究中，我们的目的是评估给予牛磺熊去氧胆酸对一组连续列入肝移植等待名单的肝硬化患者的生化、临床和功能参数的影响。
10例肝硬化患者在列入肝移植等待名单时接受了生化、临床和功能评估，然后给予牛磺熊去氧胆酸直至进行肝移植。每2个月重复进行一次全面评估。将结果与研究前一年接受肝移植的可比历史对照组的结果进行比较。
所有患者在列入等待名单后的6个月内均接受了移植。对治疗组的纵向分析表明，胆汁淤积和细胞溶解参数持续下降，并且在治疗第4个月时，γ-谷氨酰转肽酶显著低于基线值。随访期间临床和功能参数保持稳定。与对照组比较显示，治疗第4个月时γ-谷氨酰转肽酶、碱性磷酸酶和两种转氨酶均降低。治疗组住院天数更少，重症监护需求更少。
用牛磺熊去氧胆酸治疗等待肝移植的终末期肝硬化患者可改善细胞溶解和胆汁淤积的生化参数，并且有助于在等待期间维持临床和功能稳定。改善的生化状况和稳定的临床功能表现可能促进更好的短期移植效果。
