Bian Congwen, Luo Jiajiao, Tang Ruizhu, Huang Hanfei, Zeng Zhong
Department of Organ Transplantation, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.
Front Med (Lausanne). 2025 Apr 10;12:1547200. doi: 10.3389/fmed.2025.1547200. eCollection 2025.
The increasing prevalence of fibrosis in donor livers raises concerns about its impact on post-transplantation outcomes, though this relationship remains unclear. This study aims to assess the effect of donor liver fibrosis on patient and graft survival following liver transplantation.
Data from the UNOS-SRTR registry (1987-2024) were analyzed, focusing on patients who received liver transplants with biopsy-proven fibrosis. The cohort was stratified based on fibrosis grade, and outcomes were compared using Cox regression and Kaplan-Meier survival analysis. Competing risk models were applied to assess specific causes for graft failure, and subgroup analyses explored the sensitivity of fibrosis on transplant outcomes.
Of the 22,897 patients, 17,926 received non-fibrotic grafts, and 4,971 had grafts with varying fibrosis grades. Donor fibrosis was associated with donor age, steatosis, and portal infiltrate, generally affecting those in better overall condition. Significant differences were observed in patient survival ( = 0.001) and graft survival ( = 0.002) between the fibrosis and non-fibrosis groups. Further analysis revealed that fibrosis increased the risk of malignancy ( = 0.028), cardiovascular disease ( = 0.017), and respiratory failure ( = 0.033), but showed lower rejection rates at six months and one year. Sensitivity analyses confirmed fibrosis as an independent risk factor, with varying effects in subgroups.
Donor liver fibrosis significantly impacts post-transplant outcomes, notably increasing the risk of all-cause mortality and graft failure. Specific causes of death, such as malignancy and cardiovascular disease, were more prevalent in recipients of fibrotic grafts, highlighting the need for further research to refine donor selection criteria.
供体肝脏纤维化的患病率不断上升，引发了人们对其对移植后结果影响的担忧，尽管这种关系仍不明确。本研究旨在评估供体肝脏纤维化对肝移植后患者和移植物存活的影响。
分析了来自UNOS-SRTR登记处（1987 - 2024年）的数据，重点关注接受经活检证实有纤维化的肝移植患者。根据纤维化分级对队列进行分层，并使用Cox回归和Kaplan-Meier生存分析比较结果。应用竞争风险模型评估移植物失败的具体原因，亚组分析探讨纤维化对移植结果的敏感性。
在22897例患者中，17926例接受了无纤维化的移植物，4971例接受了不同纤维化分级的移植物。供体纤维化与供体年龄、脂肪变性和门脉浸润有关，通常影响总体状况较好的患者。纤维化组和非纤维化组在患者生存率（P = 0.001）和移植物生存率（P = 0.002）方面存在显著差异。进一步分析显示，纤维化增加了恶性肿瘤（P = 0.028）、心血管疾病（P = 0.017）和呼吸衰竭（P = 0.033）的风险，但在6个月和1年时排斥率较低。敏感性分析证实纤维化是一个独立的危险因素，在亚组中有不同的影响。
供体肝脏纤维化对移植后结果有显著影响，特别是增加了全因死亡率和移植物失败的风险。纤维化移植物受者中，恶性肿瘤和心血管疾病等特定死亡原因更为普遍，这凸显了进一步研究以完善供体选择标准的必要性。
