Kogiso Tomomi, Egawa Hiroto, Teramukai Satoshi, Taniai Makiko, Hashimoto Etsuko, Tokushige Katsutoshi, Sakisaka Shotaro, Sakabayashi Satomi, Yamamoto Masakazu, Umeshita Koji, Uemoto Shinji
Department of Internal Medicine, Tokyo Women's Medical University Tokyo Japan.
Department of Surgery, Institute of Gastroenterology Tokyo Women's Medical University Tokyo Japan.
Hepatol Commun. 2017 May 16;1(5):394-405. doi: 10.1002/hep4.1037. eCollection 2017 Jul.
Primary biliary cholangitis (PBC) is diagnosed mainly in female individuals, and risk factors for PBC recurrence (rPBC) after liver transplantation (LT) from cadaveric donors have been reported. We conducted a retrospective multicenter study of rPBC in female patients after living-donor LT (LDLT). A total of 388 female patients undergoing LDLT for end-stage PBC were enrolled, and the effects of preoperative and operative factors were evaluated. Postoperative factors were evaluated in 312 patients who survived for more than 1 year post-LDLT. rPBC was defined as abnormal hepatic enzyme levels with typical histological findings in liver biopsies. Fifty-eight patients (14.9%) developed rPBC with a median of 4.6 (0.8-14.5) years post-LT. Cox hazard analysis ( < 0.05) showed that younger recipient age (hazard ratio, 0.95; 95% confidence interval, 0.920-0.982), shorter operative time (1.00; 0.995-0.999), higher serum immunoglobulin M level (1.00; 1.001-1.002), donor sex mismatch (2.45; 1.268-4.736), human leukocyte antigen B60 (2.56; 1.336-4.921) and DR8 (1.98; 1.134-3.448), and initial treatment with cyclosporine A (3.14; 1.602-6.138) were significantly associated with rPBC. The frequencies of Child-Turcotte-Pugh class C (0.46; 0.274-0.775), the model of end-stage liver disease score (0.96; 0.914-0.998), and updated Mayo risk score (1.02; 1.005-1.033) were significantly lower in rPBC. Posttransplantation use of steroids decreased and that of antimetabolites increased the frequency of rPBC. : The timing of LT, recipient conditions, donor characteristics, and immunosuppressive medications may be associated with rPBC in LT recipients. ( 2017;1:394-405).
原发性胆汁性胆管炎（PBC）主要在女性个体中被诊断出来，并且已有关于尸体供体肝移植（LT）后PBC复发（rPBC）的危险因素的报道。我们对活体供体肝移植（LDLT）术后女性患者的rPBC进行了一项回顾性多中心研究。总共纳入了388例因终末期PBC接受LDLT的女性患者，并评估了术前和手术因素的影响。对LDLT术后存活超过1年的312例患者评估了术后因素。rPBC被定义为肝活检中具有典型组织学表现的肝酶水平异常。58例患者（14.9%）发生了rPBC，肝移植后中位时间为4.6（0.8 - 14.5）年。Cox风险分析（<0.05）显示，受者年龄较小（风险比，0.95；95%置信区间，0.920 - 0.982）、手术时间较短（1.00；0.995 - 0.999）、血清免疫球蛋白M水平较高（1.00；1.001 - 1.002）、供体性别不匹配（2.45；1.268 - 4.736）、人类白细胞抗原B60（2.56；1.336 - 4.921）和DR8（1.98；1.134 - 3.448）以及初始使用环孢素A治疗（3.14；1.602 - 6.138）与rPBC显著相关。Child - Turcotte - Pugh C级（0.46；0.274 - 0.775）、终末期肝病模型评分（0.96；0.914 - 0.998）和更新的梅奥风险评分（1.02；1.005 - 1.033）在rPBC中的频率显著较低。移植后使用类固醇减少以及使用抗代谢药物增加了rPBC的发生率。肝移植的时机、受者状况、供体特征和免疫抑制药物可能与肝移植受者的rPBC有关。（2017；1：394 - 405）
