肝移植后肠道菌血症是原发性硬化性胆管炎复发的危险因素。

Intestinal Bacteremia After Liver Transplantation Is a Risk Factor for Recurrence of Primary Sclerosing Cholangitis.

机构信息

Department of Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, The Netherlands.

Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, The Netherlands.

出版信息

Transplantation. 2023 Aug 1;107(8):1764-1775. doi: 10.1097/TP.0000000000004563. Epub 2023 Mar 29.

DOI:10.1097/TP.0000000000004563

PMID:36978227

Abstract

BACKGROUND

Primary sclerosing cholangitis (PSC) is a chronic progressive pathological process, related to inflammatory bowel disease and subsequent bacterial translocation. Liver transplantation (LT) is the only curative therapy, but outcomes are compromised by recurrence of PSC (rPSC). The aim of the study was to investigate a potential link between intestinal bacteremia, fucosyltransferase-2 (FUT2), and rPSC after LT.

METHODS

LT recipients with PSC (n = 81) or without PSC (n = 271) were analyzed for clinical outcomes and positive bacterial blood cultures. A link between bacteremia and the genetic variant of the FUT2 gene was investigated.

RESULTS

The incidence of inflammatory bowel disease was significantly higher in PSC recipients but not associated with rPSC. Bacteremia occurred in 31% of PSC recipients. The incidence of rPSC was 37% and was significantly more common in patients with intestinal bacteremia versus no bacteremia (82% versus 30%; P = 0.003). The nonsecretor polymorphism of the FUT2 gene was identified as a genetic risk factor for both intestinal bacteremia and rPSC. Combined FUT2 genotype and intestinal bacteremia in recipients resulted in the highest risk for rPSC (hazard ratio, 15.3; P < 0.001).

CONCLUSIONS

Thus, in this article, we showed that bacterial translocation is associated with rPSC after LT and related to the FUT2 nonsecretor status.

摘要

背景

原发性硬化性胆管炎（PSC）是一种慢性进行性病理过程，与炎症性肠病和随后的细菌易位有关。肝移植（LT）是唯一的治愈性治疗方法，但由于PSC 的复发（rPSC），结果受到影响。本研究旨在探讨 LT 后肠道菌血症、岩藻糖基转移酶-2（FUT2）与 rPSC 之间的潜在联系。

方法

分析了 81 例 PSC 肝移植受者（PSC 组）和 271 例无 PSC 肝移植受者（非 PSC 组）的临床结局和阳性血培养结果。研究了菌血症与 FUT2 基因遗传变异之间的关系。

结果

PSC 受者的炎症性肠病发病率明显较高，但与 rPSC 无关。31%的 PSC 受者发生菌血症。rPSC 的发生率为 37%，且在有肠道菌血症的患者中明显高于无菌血症的患者（82%比 30%；P = 0.003）。FUT2 基因的非分泌型多态性被确定为肠道菌血症和 rPSC 的遗传危险因素。受者的 FUT2 基因型和肠道菌血症的组合导致 rPSC 的风险最高（风险比，15.3；P < 0.001）。