Departments of Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
HPB (Oxford). 2011 Jun;13(6):417-25. doi: 10.1111/j.1477-2574.2011.00310.x. Epub 2011 Apr 7.
Macrovesicular steatosis is assumed to be an important risk factor for early allograft dysfunction (EAD) after orthotopic liver transplantation (OLT).
To evaluate the impact of steatosis in combination with other risk factors on the outcome of OLT.
The degree of steatosis was analysed in 165 consecutive OLTs and was classified by histological examination as non (M0), mild (<30%, M1), moderate (30-60%, M2) or severe steatosis (>60%, M3). Recipients were analysed for EAD.
EAD was observed in 28% of patients with M0, 26% with M1, 53% with M2 and 73% with M3 (P < 0.001). Patients with EAD had a significantly shorter graft survival after liver transplantation (P = 0.005) but did not correlate with survival. In multivariate regression analysis, the grade of steatosis, donating after cardiocirculatory death (DCD) grafts and duration of cold ischaemia time were significantly associated with EAD (P < 0.001, P = 0.01 and P = 0.001, respectively).
Livers with severe (M3) steatosis from DCD donors, combined with a prolonged CIT have a high risk for developing EAD which is correlated with shorter graft survival. Therefore M3 livers should only be considered for OLT in selected recipients without the presence of additional risk factors.
巨泡性脂肪变性被认为是原位肝移植（OLT）后早期移植物功能障碍（EAD）的一个重要危险因素。
评估脂肪变性与其他危险因素结合对 OLT 结果的影响。
在 165 例连续 OLT 中分析了脂肪变性的程度，并通过组织学检查将其分为非（M0）、轻度（<30%，M1）、中度（30-60%，M2）或重度脂肪变性（>60%，M3）。分析了受体的 EAD。
M0 患者中 EAD 发生率为 28%，M1 为 26%，M2 为 53%，M3 为 73%（P < 0.001）。发生 EAD 的患者肝移植后移植物存活率明显缩短（P = 0.005），但与存活率无关。多变量回归分析显示，脂肪变性程度、心脏循环死亡后供体（DCD）和冷缺血时间的持续时间与 EAD 显著相关（P < 0.001、P = 0.01 和 P = 0.001）。
来自 DCD 供体的严重（M3）脂肪变性的肝脏，加上较长的 CIT，发生 EAD 的风险很高，与移植物存活率缩短相关。因此，只有在没有其他危险因素的情况下，M3 肝脏才应考虑用于特定受体的 OLT。
