Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.
Clin Transplant. 2018 Dec;32(12):e13438. doi: 10.1111/ctr.13438. Epub 2018 Nov 22.
The clinical significance of apoptosis in assessing the quality of donor liver grafts remains unknown.
This study aimed to determine whether apoptosis in a donor liver is predictive of early allograft dysfunction (EAD) and graft survival after liver transplantation (LT).
Donor liver specimens were analyzed for apoptosis using TUNEL assays. The prognostic factors for EAD were identified through logistic regression analyses, and a nomogram was developed.
The apoptosis index of donor livers in EAD patients was significantly higher than that of donors livers in non-EAD patients (median 5.3; interquartile range [IQR] 3.4 vs 3.5; 3.6, P < 0.001). Multivariate analyses identified the apoptosis index of the donor liver (HR = 6.927, P < 0.001) and five other characteristics as independent predictors of EAD. A nomogram built on these predictive variables showed good calibration and discriminatory abilities, with a c-index value of 0.847. The 30-day graft survival rates in the high apoptosis index (apoptosis index >4.4%) group were significantly lower than those in the low apoptosis index (apoptosis index ≤4.4%) group (84.4% vs 97.6%, P = 0.004).
Donor liver apoptosis plays a significant role in predicting EAD after LT. Furthermore, a high apoptosis index in the donor liver was associated with inferior graft survival in the short-term.
凋亡在评估供体肝质量中的临床意义尚不清楚。
本研究旨在确定供体肝中的凋亡是否可预测肝移植（LT）后早期移植物功能障碍（EAD）和移植物存活率。
使用 TUNEL 检测法分析供体肝组织中的凋亡。通过逻辑回归分析确定 EAD 的预测因素，并制定列线图。
EAD 患者供体肝的凋亡指数明显高于非 EAD 患者（中位数 5.3；四分位距 [IQR] 3.4 比 3.5；3.6，P<0.001）。多变量分析确定供体肝的凋亡指数（HR=6.927，P<0.001）和其他五个特征是 EAD 的独立预测因子。基于这些预测变量构建的列线图显示出良好的校准和区分能力，C 指数值为 0.847。高凋亡指数（凋亡指数>4.4%）组的 30 天移植物存活率明显低于低凋亡指数（凋亡指数≤4.4%）组（84.4%比 97.6%，P=0.004）。
供体肝凋亡在预测 LT 后 EAD 中起重要作用。此外，供体肝中凋亡指数较高与短期移植物存活率降低相关。
