Department of Surgery, University Hospital Regensburg, Regensburg, Germany.
Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany.
Clin Transplant. 2023 Mar;37(3):e14880. doi: 10.1111/ctr.14880. Epub 2023 Jan 3.
Early patient and allograft survival after liver transplantation (LT) depend primarily on parenchymal function, but long-term allograft success relies often on biliary-tree function. We examined parameters related to cholangiocyte damage that predict poor long-term LT outcomes after donation after brain death (DBD).
Sixty bile ducts (BD) were assessed by a BD damage-score and divided into groups with "major" BD-damage (n = 33) and "no relevant" damage (n = 27) during static cold storage. Patients with "major" BD damage were further investigated by measuring biliary excretion parameters in the first 14 days post-LT (followed-up for 60-months).
Patients who received LT showing "major" BD damage had significantly worse long-term patient survival, versus grafts with "no relevant" damage (p = .03). When "major" BD damage developed, low bilirubin levels (p = .012) and high gamma-glutamyl transferase (GGT)/bilirubin ratio (p = .0003) were evident in the early post-LT phase (7-14 days) in patients who survived (> 60 months), compared to those who did not. "High risk" patients with bile duct damage and low GGT/bilirubin ratio had significantly shorter overall survival (p < .0001).
Once "major" BD damage occurs, a high GGT/bilirubin ratio in the early post-operative phase is likely indicator of liver and cholangiocyte regeneration, and thus a harbinger of good overall outcomes. "Major" BD damage without markers of regeneration identifies LT patients that could benefit from future repair therapies.
肝移植（LT）后患者和移植物的早期存活主要取决于实质功能，但长期移植物成功通常依赖于胆管树功能。我们研究了与胆管细胞损伤相关的参数，这些参数预测了脑死亡供体（DBD）后 LT 结局不良的长期风险。
通过胆管损伤评分评估 60 个胆管（BD），并在静态冷保存期间将其分为“主要”BD 损伤组（n=33）和“无相关”损伤组（n=27）。对“主要”BD 损伤的患者进一步通过测量 LT 后第 14 天内的胆汁排泄参数进行研究（随访 60 个月）。
与“无相关”损伤的移植物相比，显示“主要”BD 损伤的 LT 患者的长期患者存活率显著更差（p=0.03）。当发生“主要”BD 损伤时，在存活时间>60 个月的患者中，LT 后早期（7-14 天）低胆红素水平（p=0.012）和高γ-谷氨酰转移酶（GGT）/胆红素比值（p=0.0003）明显升高，而在未存活的患者中则没有。具有胆管损伤和低 GGT/胆红素比值的“高危”患者的总生存时间明显缩短（p<0.0001）。
一旦发生“主要”BD 损伤，术后早期 GGT/胆红素比值升高可能是肝和胆管细胞再生的标志物，因此是良好总预后的预示因素。没有再生标志物的“主要”BD 损伤可识别 LT 患者，这些患者可能受益于未来的修复治疗。
