基于超声的多模态成像预测活体肝移植术后缺血型胆管病变
Ultrasound-Based Multimodal Imaging Predicting Ischemic-Type Biliary Lesions After Living-Donor Liver Transplantation.
作者信息
Liu Jin-Qiao, Chen Wen-Juan, Zhou Meng-Jie, Li Wen-Feng, Tang Ju
机构信息
Department of Ultrasound, Hunan Children's Hospital, Changsha City, Hunan Province, People's Republic of China.
出版信息
Int J Gen Med. 2021 Apr 30;14:1599-1609. doi: 10.2147/IJGM.S305827. eCollection 2021.
BACKGROUND
Ischemic-type biliary lesions (ITBL) are accepted as the most incomprehensible biliary complications after living-donor liver transplantation (LDLT). Early predicting the development of ITBL in pediatric patients permits more preventive strategies. However, few studies have focused on the early prediction of ITBL.
OBJECTIVE
This study aimed to establish a nomogram including ultrasound-based multimodal imaging to predict ITBL in children with biliary atresia (BA) within 2 years after receiving LDLT.
METHODS
The records of 94 BA children with at least one year of follow-up after LDLT were reviewed retrospectively. They were randomly divided into a training cohort for constructing a nomogram (n=64) and a validation cohort (n=30). In the training cohort, patients diagnosed as ITBL were included in the ITBL group and those without any vascular and biliary complication were included in the non-ITBL group. Multivariate Cox regression was used for the establishment of the nomogram in predicting the risk of ITBL within 2 years post-LDLT. The discrimination and calibration of the nomogram were internally and externally validated. The performances of the nomogram and the individual components were compared by the area under the curve (AUC) of receiver operating characteristic (ROC) curve.
RESULTS
In the training cohort, 18 BA children were included in the ITBL group and 46 were in the non-ITBL group. Last pediatric end-stage liver disease (PELD) score, gamma-glutamyl transpeptidase (GGT), resistive index (RI), and liver stiffness measurement (LSM) were the independent predictors for the development of ITBL within 2 years post-LDLT. The nomogram incorporating these independent predictors showed good discrimination and calibration by the internal and external validation. Its performance was better than any individual component in predicting the prognosis ( < 0.05).
CONCLUSION
The established nomogram may be used to predict the risk of ITBL within 2 years post-LDLT in BA children.
背景
缺血型胆管病变（ITBL）被认为是活体肝移植（LDLT）后最难以理解的胆管并发症。早期预测小儿患者ITBL的发生有助于采取更多预防策略。然而，很少有研究关注ITBL的早期预测。
目的
本研究旨在建立一个包含基于超声的多模态成像的列线图，以预测胆管闭锁（BA）患儿在接受LDLT后2年内发生ITBL的情况。
方法
回顾性分析94例接受LDLT后至少随访1年的BA患儿的记录。他们被随机分为用于构建列线图的训练队列（n = 64）和验证队列（n = 30）。在训练队列中，被诊断为ITBL的患者纳入ITBL组，无任何血管和胆管并发症的患者纳入非ITBL组。采用多变量Cox回归建立列线图，以预测LDLT后2年内发生ITBL的风险。对列线图的区分度和校准度进行内部和外部验证。通过受试者操作特征（ROC）曲线的曲线下面积（AUC）比较列线图和各个组件的性能。
结果
在训练队列中，ITBL组纳入18例BA患儿，非ITBL组纳入46例。末次小儿终末期肝病（PELD）评分、γ-谷氨酰转肽酶（GGT）、阻力指数（RI）和肝脏硬度测量值（LSM）是LDLT后2年内发生ITBL的独立预测因素。纳入这些独立预测因素的列线图经内部和外部验证显示出良好的区分度和校准度。在预测预后方面，其性能优于任何单个组件（P < 0.05）。
结论
所建立的列线图可用于预测BA患儿LDLT后2年内发生ITBL的风险。
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