Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
Hepatology. 2011 Dec;54(6):2114-24. doi: 10.1002/hep.24635.
Serum ferritin (SF) concentration is a widely available parameter used to assess iron homeostasis. It has been described as a marker to identify high-risk patients awaiting liver transplantation (LT) but is also elevated in systemic immune-mediated diseases, metabolic syndrome, and in hemodialysis where it is associated with an inferior prognosis. This study analyzed whether SF is not only a predictor of liver-related mortality prior to LT but also an independent marker of survival following LT. In a dual-center, retrospective study, a cohort of 328 consecutive first-LT patients from Hannover Medical School, Germany (2003-2008, follow-up 1260 days), and 82 consecutive LT patients from Regensburg University Hospital, Germany (2003-2007, follow-up 1355 days) as validation cohort were analyzed. In patients exhibiting SF ≥365 μg/L versus <365 μg/L prior to LT, 1-, 3-, and 5-year post-LT survival was 73.3% versus 81.1%, 64.4% versus 77.3%, and 61.1% versus 74.4%, respectively (overall survival P = 0.0097), which was confirmed in the validation cohort (overall survival of 55% versus 83.3%, P = 0.005). Multivariate analyses identified SF ≥365 μg/L combined with transferrin saturation (TFS) <55%, hepatocellular carcinoma, and the survival after LT (SALT) score as independent risk factors for death. In patients with SF concentrations ≥365 μg/L and TFS <55%, overall survival was 54% versus 74.8% in the remaining group (P = 0.003). In the validation cohort, it was 28.6% versus 72% (P = 0.017), respectively.
SF concentration ≥365 μg/L in combination with TFS <55% before LT is an independent risk factor for mortality following LT. Lower TFS combined with elevated SF concentrations indicate that acute phase mechanisms beyond iron overload may play a prognostic role. SF concentration therefore not only predicts pre-LT mortality but also death following LT.
血清铁蛋白（SF）浓度是一种广泛用于评估铁稳态的参数。它已被描述为识别等待肝移植（LT）的高危患者的标志物，但也存在于系统性免疫介导的疾病、代谢综合征和血液透析中，在这些情况下，SF 与预后不良相关。本研究分析了 SF 是否不仅是 LT 前与肝脏相关死亡率的预测因素，而且是 LT 后生存的独立标志物。在一项来自德国汉诺威医学院的 328 例连续首次 LT 患者（2003-2008 年，随访 1260 天）和来自德国雷根斯堡大学医院的 82 例连续 LT 患者（2003-2007 年，随访 1355 天）的双中心回顾性研究中，对队列进行了分析。在 LT 前 SF≥365μg/L 与 SF＜365μg/L 的患者中，LT 后 1、3 和 5 年的生存率分别为 73.3%与 81.1%、64.4%与 77.3%和 61.1%与 74.4%（总生存率 P=0.0097），在验证队列中也得到了证实（总生存率为 55%与 83.3%，P=0.005）。多变量分析确定 SF≥365μg/L 联合转铁蛋白饱和度（TFS）＜55%、肝细胞癌和 LT 后生存率（SALT）评分是死亡的独立危险因素。在 SF 浓度≥365μg/L 和 TFS＜55%的患者中，总生存率分别为 54%与 74.8%（P=0.003）。在验证队列中，分别为 28.6%与 72%（P=0.017）。
LT 前 SF 浓度≥365μg/L 联合 TFS＜55%是 LT 后死亡率的独立危险因素。较低的 TFS 结合升高的 SF 浓度表明，铁过载之外的急性期机制可能具有预后作用。因此，SF 浓度不仅可以预测 LT 前的死亡率，还可以预测 LT 后的死亡率。
