Carey Elizabeth J, Gautam Manjushree, Ingall Timothy, Douglas David D
Division of Transplantation Medicine, Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
Liver Transpl. 2008 Feb;14(2):235-9. doi: 10.1002/lt.21350.
Autonomic dysfunction is a recognized complication of end-stage liver disease (ESLD), but there is little information on how liver transplantation (LT) affects this problem. We sought to prospectively evaluate autonomic function in patients with ESLD before and after LT. Autonomic reflex screen (ARS) was performed on 30 patients with ESLD prior to transplantation. A 10-point composite autonomic score (CAS) was calculated from these data. ARS was repeated after LT, and these scores were compared with the pre-LT ARS. Thirty patients (25 male, 5 female) with cirrhosis that were listed for LT were enrolled in the study and underwent ARS prior to LT. The average age was 55.4 +/- 9.1 years. Indications for LT included hepatitis C virus (14), cryptogenic cirrhosis (5), alcoholic cirrhosis (4), and other (7). The mean native Model for End-Stage Liver Disease (MELD) score at ARS was 17.0 +/- 5.0. Prior to LT, 86.7% of patients had evidence of autonomic dysfunction. Mean CAS was 2.7 +/- 2.2. Sudomotor function was disturbed in 66%, parasympathetic function was disturbed in 57%, and adrenergic function was disturbed in 37%. There was no relationship between pre-LT CAS and age, gender, diabetes, etiology of liver disease, or MELD score. Twenty-one patients (17 male, 4 female) had repeat ARS a mean of 9 +/- 6.2 months after LT. The mean native MELD score at the time of ARS testing was 18.1 +/- 4.3. Mean pre-LT CAS in this group was 3.0 +/- 2.4. Pretransplant CAS was not related to age, gender, diabetes, or MELD score. Autonomic dysfunction improved after LT (CAS pre-LT, 3.0, versus CAS post-LT, 1.9, P = 0.02). There was no relationship between post-LT CAS and age, gender, diabetes, etiology of liver disease, immunosuppression, or type of transplant. In conclusion, autonomic dysfunction is common in patients with ESLD, with over 86% having abnormal testing. Sixty-three percent of patients with cirrhosis with autonomic dysfunction show improvement after LT.
自主神经功能障碍是终末期肝病（ESLD）公认的并发症，但关于肝移植（LT）如何影响这一问题的信息却很少。我们试图前瞻性地评估ESLD患者在LT前后的自主神经功能。对30例ESLD患者在移植前进行自主神经反射筛查（ARS）。根据这些数据计算出一个10分的综合自主神经评分（CAS）。LT后重复进行ARS，并将这些评分与LT前的ARS进行比较。30例（25例男性，5例女性）因肝硬化而列入LT名单的患者被纳入研究，并在LT前接受了ARS。平均年龄为55.4±9.1岁。LT的适应证包括丙型肝炎病毒（14例）、隐源性肝硬化（5例）、酒精性肝硬化（4例）和其他（7例）。ARS时终末期肝病模型（MELD）的平均原始评分是17.0±5.0。LT前，86.7%的患者有自主神经功能障碍的证据。平均CAS为2.7±2.2。66%的患者汗腺运动功能受损，57%的患者副交感神经功能受损，37%的患者肾上腺素能功能受损。LT前的CAS与年龄、性别、糖尿病、肝病病因或MELD评分之间没有关系。21例（17例男性，4例女性）患者在LT后平均9±6.2个月进行了重复ARS。ARS检测时终末期肝病模型的平均原始评分是18.1±4.3。该组LT前的平均CAS为3.0±2.4。移植前的CAS与年龄、性别、糖尿病或MELD评分无关。LT后自主神经功能障碍有所改善（LT前CAS为3.0，LT后CAS为1.9，P = 0.02）。LT后的CAS与年龄、性别、糖尿病、肝病病因、免疫抑制或移植类型之间没有关系。总之，自主神经功能障碍在ESLD患者中很常见，超过86%的患者检测异常。63%有自主神经功能障碍的肝硬化患者在LT后病情有所改善。
