移植肝脂肪变性对肝移植后肝功能及器官存活的影响。

Effect of graft steatosis on liver function and organ survival after liver transplantation.

作者信息

Angele Martin K, Rentsch Markus, Hartl Wolfgang H, Wittmann Benedikt, Graeb Christian, Jauch Karl Walter, Loehe Florian

机构信息

Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians University Munich, Marchioninistr. 15, D-81377 Munich, Germany.

出版信息

Am J Surg. 2008 Feb;195(2):214-20. doi: 10.1016/j.amjsurg.2007.02.023.

DOI:10.1016/j.amjsurg.2007.02.023

PMID:18154767

Abstract

BACKGROUND

It was the aim to determine the effect of graft steatosis on intraoperative organ blood flow, postoperative liver function, and organ survival.

METHODS

A total of 225 consecutive liver transplants were reviewed. Liver blood flow, hepatic function (AST, ALT, prothrombin time), and organ survival were determined. Donor liver grafts were categorized into 2 subgroups: mild (<30%) (n = 175) and moderate to severe (>/=30%) (n = 50) macrovesicular steatosis.

RESULTS

Moderate to severe steatosis was associated with significantly increased AST and ALT levels and significantly diminished prothrombin time on the first and second postoperative day. By day 7 differences in liver function were no longer evident. Organ blood flow was not affected by steatosis. After adjustment for potential confounders, organ survival did not depend on the degree of donor steatosis (5-year-survival rates: 68% and 58% with steatosis <30%, or >/= 30%, respectively) (hazard ratio .754, confidence interval .458-1.242, P = .268).

CONCLUSION

Steatotic livers can be transplanted safely with good results for long-term organ survival if other contraindications are absent.

摘要

背景

目的是确定移植肝脂肪变性对术中器官血流、术后肝功能及器官存活的影响。

方法

回顾了连续225例肝移植病例。测定肝血流、肝功能（谷草转氨酶、谷丙转氨酶、凝血酶原时间）及器官存活情况。供肝分为两个亚组：轻度（<30%）（n = 175）和中重度（≥30%）（n = 50）大泡性脂肪变性。

结果

中重度脂肪变性与术后第1天和第2天谷草转氨酶和谷丙转氨酶水平显著升高及凝血酶原时间显著缩短有关。到第7天，肝功能差异不再明显。器官血流不受脂肪变性影响。在对潜在混杂因素进行校正后，器官存活不取决于供肝脂肪变性程度（脂肪变性<30%或≥30%的5年生存率分别为68%和58%）（风险比0.754，置信区间0.458 - 1.242，P = 0.268）。