Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.
Transpl Int. 2021 Jul;34(7):1261-1270. doi: 10.1111/tri.13828. Epub 2021 Jun 7.
The use of steatotic livers in liver transplantation (LT) is controversial. Ischaemia-free liver transplantation (IFLT) has obvious advantages for the recovery of allograft function. The aim of this study was to examine the effect of liver grafts with steatosis on outcome and the effect of IFLT with steatotic livers. 360 patients with LT were enrolled in this study. Perioperative characteristics and differences in outcome among different grades of steatotic groups, and between the IFLT and conventional LT (CLT) groups were analysed. Occurrence of early allograft dysfunction (EAD; 50%) and primary nonfunction (PNF; 20%) was significantly higher in the severe steatosis group (P < 0.001 and <0.001, respectively). Survival rate is significantly low in severe steatosis group (3-year: 60%, P = 0.0039). The IFLT group had a significantly lower occurrence of EAD than the CLT group (0% vs. 60%, P = 0.01). The level of postoperative peak AST, GGT and creatine were significantly lower in IFLT group (P = 0.009, 0.032 and 0.024, respectively). In multivariable analysis, IFLT and EAD were independent factors affecting postoperative survival. Severe steatotic livers lead to severe complications and poor outcomes in LT. IFLT has obvious advantages for reducing the rate of EAD in LT with steatotic livers.
在肝移植（LT）中使用脂肪肝存在争议。无缺血性肝移植（IFLT）对供体功能的恢复有明显优势。本研究旨在研究脂肪肝对肝移植结局的影响以及 IFLT 对脂肪肝的影响。本研究纳入了 360 例 LT 患者。分析了不同脂肪肝程度组之间以及 IFLT 组和常规 LT（CLT）组之间的围手术期特征和结局差异。严重脂肪肝组的早期移植物功能障碍（EAD；50%）和原发性无功能（PNF；20%）发生率明显更高（P<0.001 和 <0.001）。严重脂肪肝组的生存率明显较低（3 年生存率：60%，P=0.0039）。IFLT 组的 EAD 发生率明显低于 CLT 组（0%比 60%，P=0.01）。IFLT 组术后峰值 AST、GGT 和肌酸激酶水平明显低于 CLT 组（P=0.009、0.032 和 0.024）。多变量分析表明，IFLT 和 EAD 是影响术后生存的独立因素。严重脂肪肝导致 LT 严重并发症和不良结局。IFLT 对降低脂肪肝 LT 中 EAD 的发生率有明显优势。
