Division of Gastroenterology and Hepatology, Department of Medicine, Oregon Health and Science University and the Portland Veterans Affairs Medical Center, Portland, OR 97219, USA.
Clin Transplant. 2010 Sep-Oct;24(5):643-51. doi: 10.1111/j.1399-0012.2009.01136.x.
Iron overload is associated with fatal cardiovascular events following liver transplantation. Myocardial iron deposits were observed post-mortem in patients who died of cardiac events after transplantation at our institution. This observation prompted testing to exclude cardiac iron in subsequent transplant candidates.
To assess the results of testing for iron overload in liver transplant candidates at our institution.
Ferritin, TIBC, and serum iron were measured in cirrhotics referred for transplantation. Patients with transferrin saturation ≥50% and ferritin ≥250 ng/mL underwent liver biopsy graded for iron. Patients with 3-4+ hepatic iron deposits underwent HFE mutation analysis and endomyocardial biopsy with iron staining.
Eight hundred and fifty-six patients were evaluated for liver transplantation between January 1997 and March 2005. Two hundred and eighty-seven patients (34%) had transferrin saturation ≥50% and ferritin ≥250 ng/mL. Patients with markers of iron overload had more advanced liver disease than those with normal iron indices. One hundred and fifty-three patients underwent liver biopsy. Twenty-six patients (17%) had 3-4+ hepatic iron staining. One patient was a C282Y heterozygote. Endomyocardial biopsy was performed in 14 patients of whom nine had cardiac iron deposition.
Non-HFE-related cardiac iron overload can occur in advanced liver disease We therefore recommend screening for cardiac iron prior to liver transplantation.
铁过载与肝移植后致命心血管事件有关。在我们机构，接受移植后死于心脏事件的患者在死后的心肌中观察到铁沉积。这一观察结果促使我们对随后的移植候选者进行铁过载检测。
评估我们机构肝移植候选者铁过载检测的结果。
对接受移植的肝硬化患者进行铁蛋白、总铁结合力和血清铁检测。转铁蛋白饱和度≥50%且铁蛋白≥250ng/ml 的患者行肝脏活检评估铁含量。肝内铁沉积 3-4+的患者行 HFE 基因突变分析和心肌活检铁染色。
1997 年 1 月至 2005 年 3 月期间，对 856 名患者进行了肝移植评估。287 名患者（34%）转铁蛋白饱和度≥50%且铁蛋白≥250ng/ml。铁过载标志物阳性患者的肝脏疾病比铁指数正常患者更为严重。153 名患者行肝活检，26 名患者（17%）肝内铁染色 3-4+。1 名患者为 C282Y 杂合子。14 名患者行心肌活检，其中 9 名患者有心脏铁沉积。
非 HFE 相关的心脏铁过载可发生于晚期肝病患者中。因此，我们建议在进行肝移植前筛查心脏铁。
