Jadhav Prafulla V, Kothakota Sunil Raviraj, Sasidharan Madhu, Kareem Harish, Nair Ajith K
Department of Gastroenterology, KIMS Hospital, Trivandrum, Kerala, India.
J Clin Exp Hepatol. 2020 May-Jun;10(3):236-244. doi: 10.1016/j.jceh.2019.07.004. Epub 2019 Jul 12.
Ischemia reperfusion injury (IRI) is an important complication of liver transplant (LT). The donor risk index, which does not incorporate steatosis, includes several variables known to impact on allograft survival. The purpose of this study was to report on donor liver allograft steatosis and its association with severity of IRI.
The aim of this study was to determine the effect of type and grade of donor liver steatosis on the occurrence and severity of IRI in LT recipients.
This was an observational study conducted at a single center over a period of 37 months from July 2013 to August 2016. Liver biopsy was performed twice, initially at the time of procurement before graft perfusion for steatosis assessment. Steatosis was classified as microsteatosis (MiS) or macrosteatosis (MaS) with mild, moderate, or severe grade. Second biopsy for IRI assessment was taken before skin closure in death donor LT (DDLT) and at the time of transaminitis in postoperative period (<72 hrs) in living donor LT (LDLT). IRI was graded as per neutrophil infiltrate, apoptosis, and hepatocyte cell dropout. Prevalence of IRI and association steatosis was studied along with other factors.
Among 53 subjects, 35 were DDLTs and 18 were LDLTs. All live donor grafts were restricted to <15% MaS and the deceased liver grafts had different type and degree of steatosis. In DDLTs, the association between occurrence of IRI and MaS was not statistically significant ( = 0.201). In DDLTs, the mild steatosis was not significantly associated with IRI. Death donor and ischemic time were significantly associated with IRI. Child's stage and MELD scores, gender, and age were not associated with risk of IRI. Severity of IRI is significantly associated with 3-month mortality ( = 0.001).
In patients with mild steatosis, IRI does not correlate with steatosis. However, more patients with moderate and severe steatosis are needed to define the relationship of the two in this group of patients.
缺血再灌注损伤（IRI）是肝移植（LT）的一种重要并发症。供体风险指数未纳入脂肪变性情况，其中包括几个已知会影响同种异体移植物存活的变量。本研究的目的是报告供体肝同种异体脂肪变性情况及其与IRI严重程度的关联。
本研究的目的是确定供体肝脂肪变性的类型和分级对LT受者中IRI发生及严重程度的影响。
这是一项在单一中心进行的观察性研究，时间跨度为2013年7月至2016年8月的37个月。进行了两次肝活检，最初在获取供肝时、在移植物灌注前用于评估脂肪变性。脂肪变性分为微脂肪变性（MiS）或大脂肪变性（MaS），并分为轻度、中度或重度。在死亡供体肝移植（DDLT）中，在皮肤缝合前进行第二次活检以评估IRI；在活体供体肝移植（LDLT）中，在术后（<72小时）转氨酶升高时进行第二次活检以评估IRI。根据中性粒细胞浸润、凋亡和肝细胞脱落情况对IRI进行分级。研究了IRI的患病率、脂肪变性的关联以及其他因素。
在53名受试者中，35名是DDLT，18名是LDLT。所有活体供体移植物的大脂肪变性均限制在<15%，而 deceased liver grafts有不同类型和程度的脂肪变性。在DDLT中，IRI发生与MaS之间的关联无统计学意义（=0.201）。在DDLT中，轻度脂肪变性与IRI无显著关联。死亡供体和缺血时间与IRI显著相关。Child分期和MELD评分、性别及年龄与IRI风险无关。IRI严重程度与3个月死亡率显著相关（=0.001）。
在轻度脂肪变性患者中，IRI与脂肪变性无相关性。然而，需要更多中度和重度脂肪变性患者来明确这组患者中二者的关系。
