Wannhoff Andreas, Rauber Conrad, Friedrich Kilian, Rupp Christian, Stremmel Wolfgang, Weiss Karl Heinz, Schemmer Peter, Gotthardt Daniel N
Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany.
United European Gastroenterol J. 2017 Feb;5(1):86-93. doi: 10.1177/2050640616650060. Epub 2016 Jul 8.
After liver transplantation (LT), there are liver-related, infectious and cardiovascular complications that contribute to reduced graft survival. These conditions are associated with an increase in the Von Willebrand factor antigen (VWF-Ag), which was previously correlated with survival in cirrhotic patients.
Evaluate VWF-Ag as a predictive marker of re-transplantation-free survival in patients after LT.
We measured VWF-Ag in patients after first LT and then followed them prospectively with regard to the primary endpoint, namely re-transplantation-free survival.
There were 6 out of 80 patients who died or received re-LT during follow-up. In these patients, the median VWF-Ag was 510.6%, which was significantly higher ( = 0.001) than in the patients who were alive at the end of follow-up (with a median VWF-Ag = 186.8%). At a cut-off of 286.8%, VWF-Ag was significantly correlated with re-transplantation-free survival ( < 0.001). VWF-Ag was independently associated with re-transplantation-free survival in a multivariate analysis; as was alkaline phosphatase (ALP), but not the model of end-stage liver disease (MELD) score, donor age, nor cold ischemia time. A score combining VWF-Ag and ALP showed an impressive capability in the receiver operating characteristic (ROC) analysis (with area under the curve (AUC) = 0.958) to distinguish between patients with regard to the primary endpoint.
VWF-Ag is a non-invasive marker that can predict outcome in patients after LT. Its diagnostic performance increased when combined with ALP in a newly developed scoring system.
肝移植（LT）后，存在与肝脏相关、感染性和心血管方面的并发症，这些并发症会导致移植物存活率降低。这些情况与血管性血友病因子抗原（VWF-Ag）升高有关，而VWF-Ag此前与肝硬化患者的生存率相关。
评估VWF-Ag作为LT术后患者无再次移植生存的预测标志物。
我们测量了首次LT术后患者的VWF-Ag，然后对他们进行前瞻性随访，观察主要终点，即无再次移植生存情况。
80例患者中有6例在随访期间死亡或接受了再次肝移植。在这些患者中，VWF-Ag的中位数为510.6%，显著高于随访结束时存活患者（VWF-Ag中位数为186.8%）（P = 0.001）。在截断值为286.8%时，VWF-Ag与无再次移植生存显著相关（P < 0.001）。在多变量分析中，VWF-Ag与无再次移植生存独立相关；碱性磷酸酶（ALP）也是如此，但终末期肝病模型（MELD）评分、供体年龄和冷缺血时间则不然。结合VWF-Ag和ALP的评分在受试者工作特征（ROC）分析中显示出强大的区分主要终点患者的能力（曲线下面积（AUC） = 0.958）。
VWF-Ag是一种可预测LT术后患者预后的非侵入性标志物。在新开发的评分系统中，将其与ALP结合时，其诊断性能有所提高。
