Oltean Mihai, Barrenäs Christian, Martins Paulo Ney, Herlenius Gustaf, Gustafsson Bengt, Friman Styrbjörn, Bennet William
The Transplant Institute, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden; Sahlgrenska Academy, The University of Gothenburg, Gothenburg, Sweden.
Sahlgrenska Academy, The University of Gothenburg, Gothenburg, Sweden.
Gastroenterol Res Pract. 2016;2016:6964856. doi: 10.1155/2016/6964856. Epub 2016 May 22.
Background. Exogenous bilirubin may reduce experimental ischemia-reperfusion injury (IRI) due to its antioxidant properties. We studied if early graft exposure to high bilirubin levels in the recipient affects the early IRI and outcomes after liver transplantation (LTx). Methods. In 427 LTx patients, the AUROC curve based on bilirubin and AST at day 1 identified a cutoff of 2.04 mg/dL for the recipient pretransplant bilirubin. Recipients were grouped as having low (group L, n = 152) or high (group H, n = 275) bilirubin. Both groups had similar donor-related variables (age, preservation time, donor BMI > 28, and donor risk index (DRI)). Results. Alanine (ALT) and aspartate (AST) aminotransferase levels were higher in group L at day 1; ALT levels remained higher at day 2 in group L. LTx from high risk donors (DRI > 2) revealed a trend towards lower transaminases during the first two days after transplantation in group H. One month and 1-year patient survival were similar in groups L and H. High preoperative bilirubin did not affect the risk for early graft dysfunction (EGD), death, or graft loss during the first year after transplantation nor the incidence of acute rejection. LTx using donors with DRI > 2 resulted in similar rates of EGD in both groups. Conclusion. Increased bilirubin appears to reduce the early IRI after LTx yet this improvement was insufficient to improve the clinical outcome.
背景。外源性胆红素因其抗氧化特性可能减轻实验性缺血再灌注损伤（IRI）。我们研究了受体早期移植肝暴露于高胆红素水平是否会影响肝移植（LTx）后的早期IRI及预后。方法。在427例LTx患者中，基于术后第1天胆红素和天冬氨酸转氨酶（AST）绘制的AUROC曲线确定受体移植前胆红素的临界值为2.04mg/dL。将受体分为低胆红素组（L组，n = 152）和高胆红素组（H组，n = 275）。两组的供体相关变量（年龄、保存时间、供体体重指数>28及供体风险指数（DRI））相似。结果。L组术后第1天丙氨酸转氨酶（ALT）和AST水平较高；L组术后第2天ALT水平仍较高。高风险供体（DRI>2）的LTx显示，H组移植后前两天转氨酶有降低趋势。L组和H组1个月及1年患者生存率相似。术前高胆红素不影响移植后第1年早期移植物功能障碍（EGD）、死亡或移植物丢失风险，也不影响急性排斥反应发生率。使用DRI>2供体的LTx两组EGD发生率相似。结论。胆红素升高似乎可减轻LTx后的早期IRI，但这种改善不足以改善临床结局。
