Department of Internal Medicine, Henry Ford Health Systems, Detroit, MI, USA.
Dig Dis Sci. 2014 Mar;59(3):674-80. doi: 10.1007/s10620-013-2955-8. Epub 2013 Dec 10.
Acute cellular rejection (ACR) is a significant cause of morbidity and graft failure in liver transplant recipients (LTR). Diastolic dysfunction (DD) is frequently present in patients with cirrhosis undergoing liver transplantation. However, it is unclear if DD leads to ACR.
Data was collected retrospectively for consecutive LTR between January 2000 and December 2010. Demographic data and mortality related data was obtained from social security index. Primary outcome was biopsy proven ACR. Graft failure and all-cause mortality were also evaluated. DD was evaluated as a predictor of these outcomes. Other echocardiographic indices were also assessed as predictors of ACR by using Cox proportional hazard modeling adjusted for covariates.
A total of 970 LTR (mean age 53.2 ± 10 years, women 34.6 % and white 64.5 %) were followed for 5.3 ± 3.4 years. Patients with DD (n = 145, 14.9 %) were significantly more likely to develop ACRs (HR 10.56; 95 % CI 6.78-16.45, p value = 0.0001) as well as graft failure (HR 2.09; 95 % CI 1.22-3.59, p value = 0.007) and all-cause mortality (HR 1.52; 95 % CI 1.08-2.13, p = 0.01). There was an increase in the risk of these outcomes with worsening of DD, when adjusted for various risk factors such as donor and recipient age, gender, race, Framingham risk score, pre-transplant MELD, transplant etiology and cold ischemia time.
Pre-transplant DD is significantly associated with increased risk of allograft rejection, graft failure and mortality. This signifies the importance of cardiac evaluation during the pre-transplant period.
急性细胞排斥（ACR）是肝移植受者（LTR）发病率和移植物失功的重要原因。接受肝移植的肝硬化患者常存在舒张功能障碍（DD）。然而，尚不清楚 DD 是否会导致 ACR。
回顾性收集 2000 年 1 月至 2010 年 12 月连续 LTR 的数据。人口统计学数据和与死亡率相关的数据从社会安全指数中获得。主要结果是活检证实的 ACR。还评估了移植物失功和全因死亡率。评估 DD 是否为这些结局的预测因素。还通过 Cox 比例风险模型评估其他超声心动图指标作为 ACR 的预测因素，该模型调整了协变量。
共对 970 例 LTR（平均年龄 53.2 ± 10 岁，女性 34.6%，白人 64.5%）进行了 5.3 ± 3.4 年的随访。患有 DD（n = 145，14.9%）的患者更有可能发生 ACR（HR 10.56；95%CI 6.78-16.45，p 值 = 0.0001）以及移植物失功（HR 2.09；95%CI 1.22-3.59，p 值 = 0.007）和全因死亡率（HR 1.52；95%CI 1.08-2.13，p = 0.01）。在调整了各种风险因素（如供体和受体年龄、性别、种族、弗雷明汉风险评分、移植前 MELD、移植病因和冷缺血时间）后，随着 DD 的恶化，这些结局的风险增加。
移植前 DD 与同种异体移植物排斥、移植物失功和死亡风险增加显著相关。这表明在移植前期间进行心脏评估的重要性。
