Lee S H, Joo D J, Kim S U, Kim M S, Lee A-L, Choi G H, Choi J S, Han K H, Kim S I
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea; Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
Transplant Proc. 2013 Oct;45(8):3028-31. doi: 10.1016/j.transproceed.2013.08.051.
Liver stiffness measurements (LSMs) using transient elastography (TE) provide a noninvasive means to assess liver fibrosis that correlate with hepatic cholestasis. However, few studies have examined the correlation of TE to obtain LSMs with perioperative clinical and laboratory parameters in living donor liver transplantation (LDLT).
We retrospectively reviewed forty-eight subjects who underwent LDLT between November 2010 and October 2012. All donors and recipients underwent TE, abdominal computed tomography (CT), and biochemical tests within 1 month before and at 1 week after transplantation. Using a cut-off LSM of 7.5 kPa, which we arbitrarily assigned to be indicative of significant fibrosis, we divided our study population into ≤7.5 kPa (group L; n = 15, 31.3%) versus >7.5 kPa; (group H; n = 33, 68.8%).
Pretransplantation serum total bilirubin, international normalized ratio, and Model for End-stage Liver Disease scores of recipients were significantly higher in group H than group L. Regarding the pretransplantation donor characteristics, the graft-recipient weight ratio was significantly smaller among those in group H (P = .039). In addition, the post-transplantation 1-week serum total bilirubin level was significantly higher in group H (2.3 mg/dL versus 1.2 mg/dL, P = .015), although neither biliary complications norhepatic congestion was identified by abdominal CT. Among the 1-week post-transplantation laboratory findings, only total bilirubin positively correlated with LSM (P = .044).
This pilot study suggested that a high LSM after LDLT suggests intrahepatic cholestasis and portal hypercirculation in the graft, irrespective of liver fibrosis, outflow obstruction, or biliary obstruction.
使用瞬时弹性成像（TE）进行肝脏硬度测量（LSM）提供了一种非侵入性手段来评估与肝内胆汁淤积相关的肝纤维化。然而，很少有研究探讨在活体肝移植（LDLT）中通过TE获得LSM与围手术期临床和实验室参数之间的相关性。
我们回顾性分析了2010年11月至2012年10月期间接受LDLT的48名受试者。所有供体和受体在移植前1个月内及移植后1周接受了TE、腹部计算机断层扫描（CT）和生化检查。使用我们任意设定的7.5 kPa的LSM截断值来指示显著纤维化，我们将研究人群分为≤7.5 kPa（L组；n = 15，31.3%）和>7.5 kPa（H组；n = 33，68.8%）。
H组受体移植前血清总胆红素、国际标准化比值和终末期肝病模型评分显著高于L组。关于移植前供体特征，H组的移植物与受体体重比显著更小（P = 0.039）。此外，H组移植后1周血清总胆红素水平显著更高（2.3 mg/dL对1.2 mg/dL，P = 0.015），尽管腹部CT未发现胆道并发症或肝淤血。在移植后1周的实验室检查结果中，只有总胆红素与LSM呈正相关（P = 0.044）。
这项初步研究表明，LDLT后高LSM提示移植物内肝内胆汁淤积和门静脉高循环，与肝纤维化、流出道梗阻或胆道梗阻无关。
