Pathology Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Transplant Surgery Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Pathol Res Pract. 2023 Mar;243:154361. doi: 10.1016/j.prp.2023.154361. Epub 2023 Feb 7.
Hypothermic oxygenated perfusion (HOPE) has become widespread for the preservation of liver grafts, making tangled the relationship among the use of extended criteria donors (ECD), graft histology and transplant outcome.
To prospectively validate the impact of the graft histology on transplant outcome in recipient receiving liver grafts from ECD after HOPE.
Ninety-three ECD grafts were prospectively enrolled; 49 (52.7 %) were perfused with HOPE according to our protocols. All clinical, histological and follow-up data were collected.
Grafts with portal fibrosis stage ≥ 3 according to Ishak's (evaluated with Reticulin stain) had a significantly higher incidence of early allograft dysfunction (EAD) and 6-month-dysfunction (p = 0.026 and p = 0.049), with more days in Intensive Care Unit (p = 0.050). Lobular fibrosis correlated with post-liver transplant kidney function (p = 0.019). Moderate-to-severe chronic portal inflammation was correlated with graft survival on both multivariate and univariate analyses (p < 0.001), but this risk factor is sensibly reduced by the execution of HOPE.
The use of liver grafts with portal fibrosis stage ≥ 3 implies a higher risk of post-transplant complications. Portal inflammation represents an important prognostic factor as well, but the execution of HOPE represents a valid tool to improve graft survival.
低温氧合灌注（HOPE）已广泛应用于保存肝移植物，这使得扩展标准供体（ECD）的使用、移植物组织学和移植结果之间的关系变得复杂。
前瞻性验证 HOPE 后接受 ECD 肝移植物的受者中移植物组织学对移植结果的影响。
前瞻性纳入 93 例 ECD 移植物；49 例（52.7%）根据我们的方案进行 HOPE 灌注。收集所有临床、组织学和随访数据。
根据 Ishak 评分（采用网状纤维染色评估），门静脉纤维化≥3 级的移植物发生早期移植物功能障碍（EAD）和 6 个月功能障碍的发生率显著更高（p=0.026 和 p=0.049），入住重症监护病房的天数也更多（p=0.050）。肝纤维化与肝移植后肾功能相关（p=0.019）。中重度慢性门静脉炎症在多变量和单变量分析中与移植物存活率相关（p<0.001），但执行 HOPE 可显著降低这一风险因素。
使用门静脉纤维化≥3 级的肝移植物意味着术后并发症的风险更高。门静脉炎症也是一个重要的预后因素，但执行 HOPE 是提高移植物存活率的有效手段。
