Zhao Xinyan, He Yafei, Liu Jimin, Zhang Qian, Liu Liwei, Qu Wei, Liu Ying, Zeng Zhigui, Zhang Haiming, Jia Jidong, Sun Liying, Wei Lin, Zhu Zhijun
Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Liver Transplant Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Hepatobiliary Surg Nutr. 2022 Jun;11(3):340-354. doi: 10.21037/hbsn-20-685.
To evaluate the impact of steatosis and/or idiopathic portal inflammation (IPI) in living donor livers on recipients' clinical outcomes.
We assessed 305 qualified donor liver samples from June 2013 to December 2018. Donors and recipients' clinical characteristics, including follow-up data were retrieved. The graft and overall survival with/without steatosis or portal inflammation were compared by Kaplan-Meier analysis.
For living donors, the medium age of was 31.2 (28, 35.8) years old; liver histopathology showed macrovesicular steatosis: 0-5% 264/305 (86.6%) and 5-30% 41/305 (13.4%), IPI: no 220/305 (72.1%) and mild 85/305 (27.9%). For recipients, the medium age was 1.0 (0.6, 1.5) years old; the median pediatric-end-stage-liver-disease score was 16 (5.0, 26.0) and medium follow-up time was 32.8 (24.8, 52.0) months. Biliary atresia (69.5%) was the main indication for liver transplantation (LT).
The presence of steatosis and portal inflammation of the donor liver did not impact the clinical outcomes including transaminase or bilirubin normalization, short-/long-term complications and recipients' survival. However, recipients with high pediatric-end-stage-liver-disease score (>16) receiving donor liver with portal inflammation, but not steatosis, had trend negative effect on recipients' survival. In conclusion, donor livers with mild steatosis and portal inflammation were qualified for pediatric living donor LT. However, donor liver with mild portal inflammation would better not be allocated to recipients with high pediatric-end-stage-liver-disease score. This study provided new evidence in pediatric living donor liver allocation.
评估活体供肝中的脂肪变性和/或特发性门静脉炎症（IPI）对受者临床结局的影响。
我们评估了2013年6月至2018年12月期间的305份合格供肝样本。收集了供者和受者的临床特征，包括随访数据。采用Kaplan-Meier分析比较有/无脂肪变性或门静脉炎症情况下的移植物和总体生存率。
对于活体供者，平均年龄为31.2（28，35.8）岁；肝脏组织病理学显示大泡性脂肪变性：0 - 5% 264/305（86.6%），5 - 30% 41/305（13.4%），IPI：无220/305（72.1%），轻度85/305（27.9%）。对于受者，平均年龄为1.0（0.6，1.5）岁；小儿终末期肝病评分中位数为16（5.0，26.0），平均随访时间为32.8（24.8，52.0）个月。胆道闭锁（69.5%）是肝移植（LT）的主要适应证。
供肝存在脂肪变性和门静脉炎症不影响临床结局，包括转氨酶或胆红素正常化、短期/长期并发症以及受者生存。然而，小儿终末期肝病评分高（>16）的受者接受有门静脉炎症但无脂肪变性的供肝，对受者生存有趋势性负面影响。总之，轻度脂肪变性和门静脉炎症的供肝可用于小儿活体供肝LT。然而，轻度门静脉炎症的供肝最好不要分配给小儿终末期肝病评分高的受者。本研究为小儿活体供肝分配提供了新证据。
