den Dulk A Claire, Sebib Korkmaz Kerem, de Rooij Bert-Jan F, Sutton Michael E, Braat Andries E, Inderson Akin, Dubbeld Jeroen, Verspaget Hein W, Porte Robert J, van Hoek Bart
Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands.
Transpl Int. 2015 Apr;28(4):492-501. doi: 10.1111/tri.12524. Epub 2015 Jan 30.
Orthotopic liver transplantation (OLT) with donation after circulatory death (DCD) often leads to a higher first week peak alanine aminotransferase (ALT) and a higher rate of biliary nonanastomotic strictures (NAS) as compared to donation after brain death (DBD). This retrospective study was to evaluate whether an association exists between peak ALT and the development of NAS in OLT with livers from DBD (n = 399) or DCD (n = 97) from two transplantation centers. Optimal cutoff value of peak ALT for risk of development of NAS post-DCD-OLT was 1300 IU/l. The 4-year cumulative incidence of NAS after DCD-OLT was 49.5% in patients with a high ALT peak post-OLT, compared with 11.3% in patients with a low ALT peak. (P < 0.001). No relation between peak ALT and NAS was observed after DBD-OLT. Multivariate analysis revealed peak ALT ≥1300 IU/l [adjusted hazard ratio (aHR) = 3.71, confidence interval (CI) (1.26-10.91)] and donor age [aHR = 1.04, CI 1.00-1.07] to be independently associated with development of NAS post-DCD-OLT. A peak ALT of <1300 IU/l carries a risk for NAS similar to DBD-OLT. Thus, in DCD-OLT, but not in DBD-OLT, peak ALT discriminates patients at high or low risk for NAS.
与脑死亡后捐赠（DBD）相比，原位肝移植（OLT）联合循环死亡后捐赠（DCD）往往会导致首周丙氨酸转氨酶（ALT）峰值更高，以及非吻合口胆管狭窄（NAS）发生率更高。这项回顾性研究旨在评估来自两个移植中心的DBD供肝（n = 399）或DCD供肝（n = 97）的OLT中，ALT峰值与NAS发生之间是否存在关联。DCD-OLT术后发生NAS风险的ALT峰值最佳截断值为1300 IU/l。OLT术后ALT峰值高的患者中，DCD-OLT术后NAS的4年累积发生率为49.5%，而ALT峰值低的患者为11.3%。（P < 0.001）。DBD-OLT术后未观察到ALT峰值与NAS之间的关系。多因素分析显示，ALT峰值≥1300 IU/l [调整后风险比（aHR）= 3.71，置信区间（CI）（1.26 - 10.91）]和供体年龄[aHR = 1.04，CI 1.00 - 1.07]与DCD-OLT术后NAS的发生独立相关。ALT峰值<1300 IU/l时发生NAS的风险与DBD-OLT相似。因此，在DCD-OLT中，而非DBD-OLT中，ALT峰值可区分NAS发生风险高或低的患者。
