Briceño Javier, Ciria Ruben, Pleguezuelo María, de la Mata Manuel, Muntané Jordi, Naranjo Alvaro, Sánchez-Hidalgo Juan, Marchal Trinidad, Rufián Sebastián, López-Cillero Pedro
Unit of Hepatobiliary Surgery and Liver Transplantation, Reina Sofía University Hospital, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas CiberEHD, Córdoba, Spain.
Liver Transpl. 2009 Jan;15(1):37-48. doi: 10.1002/lt.21566.
The aim of this study was to determine the influence of donor graft steatosis on overall outcome, viral recurrence, and fibrosis progression in orthotopic liver transplantation (OLT) for hepatitis C virus (HCV) cirrhosis. One hundred twenty patients who underwent OLT for HCV cirrhosis between 1995 and 2005 were included in the study. Donor steatosis was categorized as absent (0%-10%; n = 40), mild (10%-30%; n = 32), moderate (30%-60%; n = 29), or severe (>60%; n = 19). A Cox multivariate analysis for marginal donor variables and a Model for End-Stage Liver Disease index were performed. Fibrosis evolution was analyzed in liver biopsies (fibrosis < 2 or > or =2) 3, 6, and 12 months post-OLT and in the late post-OLT period. Fifty-six grafts were lost (46%). The survival of the grafts was inversely proportional to donor liver steatosis: 82%, 72%, and 72% at 1, 2, and 3 years post-OLT in the absence of steatosis; 73%, 63%, and 58% with mild steatosis; 74%, 62%, and 43% with moderate steatosis; and 62%, 49%, and 42% with severe steatosis (P = 0.012). HCV recurrence was earlier and more frequent in recipients with steatosis > 30% (46% versus 32% at 3 months, P = 0.017; 58% versus 43% at 6 months, P = 0.020; 70% versus 56% at 12 months, P = 0.058; and 95% versus 69% at 3 years post-OLT, P = 0.0001). Graft survival was lower in alcoholic liver disease recipients versus HCV recipients when steatosis was >30% at 3, 6, and 12 months post-OLT (P = 0.042) but not when steatosis was <30% (P = 0.53). A higher fibrosis score was obtained 3 months post-OLT (P = 0.033), 6 months post-OLT (P = 0.306), 12 months post-OLT (P = 0.035), and in the late post-OLT period (P = 0.009). In conclusion, donor graft steatosis influences the outcome of OLT for HCV cirrhosis. HCV recurrence is more frequent and earlier in recipients of moderately and severely steatotic livers. Fibrosis evolution is higher when graft steatosis is >30%. OLT with >30% steatotic donor livers should be precluded in HCV recipients.
本研究旨在确定供体移植物脂肪变性对丙型肝炎病毒（HCV）肝硬化原位肝移植（OLT）的总体预后、病毒复发及纤维化进展的影响。本研究纳入了1995年至2005年间因HCV肝硬化接受OLT的120例患者。供体脂肪变性分为无（0%-10%；n = 40）、轻度（10%-30%；n = 32）、中度（30%-60%；n = 29）或重度（>60%；n = 19）。对边缘供体变量进行了Cox多因素分析，并计算了终末期肝病模型指数。在OLT术后3、6和12个月以及OLT术后晚期，对肝活检组织（纤维化<2或≥2）的纤维化演变情况进行了分析。56例移植物失功（46%）。移植物存活率与供体肝脂肪变性呈负相关：无脂肪变性时，OLT术后1、2和3年的存活率分别为82%、72%和72%；轻度脂肪变性时为73%、63%和58%；中度脂肪变性时为74%、62%和43%；重度脂肪变性时为62%、49%和42%（P = 0.012）。脂肪变性>30%的受者中HCV复发更早且更频繁（OLT术后3个月时为46%对32%，P = 0.017；6个月时为58%对43%，P = 0.020；12个月时为70%对56%，P = 0.058；OLT术后3年时为95%对69%，P = 0.0001）。当OLT术后3、6和12个月脂肪变性>30%时，酒精性肝病受者的移植物存活率低于HCV受者（P = 0.042），但脂肪变性<30%时则无差异（P = 0.53）。OLT术后3个月（P = 0.033）、6个月（P = 0.306）、12个月（P = 0.035）及OLT术后晚期（P = 0.009）的纤维化评分更高。总之，供体移植物脂肪变性影响HCV肝硬化OLT的预后。中度和重度脂肪变性肝脏受者中HCV复发更频繁且更早。当移植物脂肪变性>30%时，纤维化进展更高。HCV受者应避免使用脂肪变性>30%的供体肝脏进行OLT。
