Swiss Hepato Pancreatico Biliary and Transplant Center Zurich, Department of Surgery and TransplantationUniversity Hospital ZurichZürichSwitzerland.
Department of Hepato Pancreatico Biliary Surgery and Liver TransplantationRoyal Free HospitalLondonUK.
Liver Transpl. 2022 Dec;28(12):1888-1898. doi: 10.1002/lt.26534. Epub 2022 Aug 5.
This study investigated the effect of low-dose aspirin in primary adult liver transplantation (LT) on acute cellular rejection (ACR) as well as arterial patency rates. The use of low-dose aspirin after LT is practiced by many transplant centers to minimize the risk of hepatic artery thrombosis (HAT), although solid recommendations do not exist. However, aspirin also possesses potent anti-inflammatory properties and might mitigate inflammatory processes after LT, such as rejection. Therefore, we hypothesized that the use of aspirin after LT has a protective effect against ACR. This is an international, multicenter cohort study of primary adult deceased donor LT. The study included 17 high-volume LT centers and covered the 3-year period from 2013 to 2015 to allow a minimum 5-year follow-up. In this cohort of 2365 patients, prophylactic antiplatelet therapy with low-dose aspirin was administered in 1436 recipients (61%). The 1-year rejection-free survival rate was 89% in the aspirin group versus 82% in the no-aspirin group (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.63-0.94; p = 0.01). The 1-year primary arterial patency rates were 99% in the aspirin group and 96% in the no-aspirin group with an HR of 0.23 (95% CI, 0.13-0.40; p < 0.001). Low-dose aspirin was associated with a lower risk of ACR and HAT after LT, especially in the first vulnerable year after transplantation. Therefore, low-dose aspirin use after primary LT should be evaluated to protect the liver graft from ACR and to maintain arterial patency.
本研究旨在探讨成人原发性肝移植（LT）中低剂量阿司匹林对急性细胞排斥（ACR）和动脉通畅率的影响。许多移植中心在 LT 后使用低剂量阿司匹林以降低肝动脉血栓形成（HAT）的风险，尽管目前尚无明确的推荐意见。然而，阿司匹林还具有强大的抗炎特性，可能减轻 LT 后如排斥等炎症过程。因此，我们假设 LT 后使用阿司匹林具有预防 ACR 的作用。这是一项针对成人原发性尸体供肝 LT 的国际多中心队列研究。该研究纳入了 17 家高容量 LT 中心，涵盖了 2013 年至 2015 年的 3 年时间，以确保至少 5 年的随访。在这 2365 例患者队列中，1436 例（61%）接受了预防性抗血小板治疗低剂量阿司匹林。阿司匹林组 1 年无排斥存活率为 89%，而无阿司匹林组为 82%（风险比[HR]，0.77；95%置信区间[CI]，0.63-0.94；p=0.01）。阿司匹林组 1 年原发性动脉通畅率为 99%，无阿司匹林组为 96%，HR 为 0.23（95%CI，0.13-0.40；p<0.001）。LT 后，低剂量阿司匹林与 ACR 和 HAT 的风险降低相关，尤其是在移植后最初的脆弱 1 年内。因此，LT 后使用低剂量阿司匹林应进行评估，以保护肝移植物免受 ACR 影响并维持动脉通畅。
