Perez-Daga J A, Santoyo J, Suárez M A, Fernández-Aguilar J A, Ramírez C, Rodríguez-Cañete A, Aranda J M, Sánchez-Pérez B, Montiel C, Palomo D, Ruiz M, Mate A
Unit of HBP Surgery and Liver Transplantation, H. R. Carlos Haya, Malaga, Spain.
Transplant Proc. 2006 Oct;38(8):2468-70. doi: 10.1016/j.transproceed.2006.08.077.
The aim of this study was to evaluate the impact on initial graft function of the degree of steatosis detected in the back-table biopsy, and its repercussion on the clinical results of the transplant (early posttransplant mortality and morbidity). We undertook a retrospective analysis of 300 liver transplants performed at our center from 1997 to 2004. A wedge liver biopsy was done routinely during back-table surgery (available in 294 transplants). The degree of steatosis was classified as: S0-no steatosis, 201 transplants; S1-mild steatosis (<30%), 58 transplants; S2-moderate steatosis (30% to 60%), 18 transplants; and S3-severe steatosis (>60%), 17 transplants. The ischemia-reperfusion (I/R) injury, based on the maximum mean peak aspartate transferase in the first 72 posttransplant hours, tended to be greater as the degree of graft steatosis increased: S0, 1316; S1, 1985; S2, 2446; and S3, 2955 (P < .005 between S0 and S3). This greater initial hepatic dysfunction was correlated in the group with severe steatosis with a higher rate of severe renal failure requiring hemofiltration/hemodialysis: S0, 9%; S1, 15%; S2, 11%; and S3, 41% (P < .001); as well as with a higher early mortality (90 days): S0, 10%; S1, 21%; S2, 11%; and S3, 41% (P < .001). The Kaplan-Meier survival curve showed a significant difference (log-rank and Breslow) between the group with severe steatosis and the group with no steatosis (P = .002). We conclude that the degree of liver graft steatosis is an important determinant of I/R injury, although this progressive increase in the I/R injury with the degree of steatosis only had clinical repercussions in the case of severe steatosis.
本研究的目的是评估在移植肝后台活检中检测到的脂肪变性程度对初始移植肝功能的影响，以及其对移植临床结果（移植后早期死亡率和发病率）的影响。我们对1997年至2004年在本中心进行的300例肝移植进行了回顾性分析。在移植肝后台手术期间常规进行楔形肝活检（294例移植可获得活检结果）。脂肪变性程度分为：S0-无脂肪变性，201例移植；S1-轻度脂肪变性（<30%），58例移植；S2-中度脂肪变性（30%至60%），18例移植；S3-重度脂肪变性（>60%），17例移植。根据移植后最初72小时内最大平均峰值天冬氨酸转氨酶计算的缺血-再灌注（I/R）损伤，随着移植肝脂肪变性程度的增加而趋于加重：S0为1316；S1为1985；S2为2446；S3为2955（S0和S3之间P<.005）。在重度脂肪变性组中，这种更严重的初始肝功能障碍与需要血液滤过/血液透析的严重肾衰竭发生率较高相关：S0为9%；S1为15%；S2为11%；S3为41%（P<.001）；也与较高的早期死亡率（90天）相关：S0为10%；S1为21%；S2为11%；S3为41%（P<.001）。Kaplan-Meier生存曲线显示，重度脂肪变性组与无脂肪变性组之间存在显著差异（对数秩检验和Breslow检验，P=.002）。我们得出结论，移植肝脂肪变性程度是I/R损伤的重要决定因素，尽管随着脂肪变性程度加重I/R损伤的这种逐渐增加仅在重度脂肪变性的情况下才产生临床影响。
