Gaffey M J, Boyd J C, Traweek S T, Ali M A, Rezeig M, Caldwell S H, Iezzoni J C, McCullough C, Stevenson W C, Khuroo S, Nezamuddin N, Ishitani M B, Pruett T L
Department of Pathology, University of Virginia Medical Center, Charlottesville 22908, USA.
Hepatology. 1997 Jan;25(1):184-9. doi: 10.1002/hep.510250134.
Eighty liver allografts were studied to determine the predictive value of intraoperative biopsies and postoperative liver function tests for the development of preservation injury (PI). Peak transaminase (aspartate transaminase [AST] and alanine transaminase [ALT]) and prothrombin time (PT) values achieved by each patient during postoperative days (POD) 1 through 7 were determined. PI in day 0 preperfusion biopsies (0Pre) (obtained immediately before implantation) and postperfusion biopsies (0Post) (obtained immediately after revascularization) was categorized by histological criteria as present or absent. PI in biopsies taken during POD 2 through 14 was histologically graded as either moderate-to-severe, mild, or absent. Of the 80 allografts, 8 were omitted because of primary nonfunction or postoperative complications. 0Pre and 0Post biopsies were available on 25 of 72 (35%) and 69 of 72 (96%) allografts, respectively. Only 2 (8%) of the 0Pre biopsies showed histological PI compared with 48 (70%) of the 0Post biopsies. Fifty-nine patients were biopsied between POD 2 through 14. Of these, 15, 28, and 16 patients developed moderate-to-severe, mild, or no evidence of PI, respectively. The presence of PI in the 0Post biopsy strongly correlated with the development of PI during POD 2 through 14 (P < .0005). Peak AST and ALT values in patients with moderate-to-severe PI on POD 2 through 14 were significantly elevated compared with those patients with either mild (P = .01 and .03) or no PI (P = .02 and .006). Because of extensive overlap in AST and ALT values between the three groups, however, transaminase values were not useful in predicting the presence or absence of PI in the individual case. The development of PI during POD 2 through 14 correlated with advanced donor age (P = .06) but was unassociated with 0Pre biopsy findings, cold ischemia time, or peak PT values. We conclude that the 0Post biopsy is a valuable tool for the prediction of subsequent PI in the early postoperative period. In contrast, 0Pre biopsy findings and peak AST and ALT values are not useful in the assessment of PI.
对80例肝移植进行研究，以确定术中活检和术后肝功能检查对保存损伤（PI）发生的预测价值。测定了每位患者在术后第1至7天达到的转氨酶峰值（天冬氨酸转氨酶[AST]和丙氨酸转氨酶[ALT]）和凝血酶原时间（PT）值。根据组织学标准将移植日0预灌注活检（0Pre）（植入前立即获取）和灌注后活检（0Post）（血管再通后立即获取）中的PI分类为存在或不存在。将术后第2至14天获取的活检中的PI组织学分级为中度至重度、轻度或不存在。在80例移植中，8例因原发性无功能或术后并发症被排除。72例移植中分别有25例（35%）和69例（96%）可获得0Pre和0Post活检。0Pre活检中只有2例（8%）显示组织学PI，而0Post活检中有48例（70%）显示。59例患者在术后第2至14天进行了活检。其中，分别有15例、28例和16例患者发生了中度至重度、轻度或无PI证据。0Post活检中PI的存在与术后第2至14天PI的发生密切相关（P <.0005）。术后第2至14天有中度至重度PI的患者的AST和ALT峰值与轻度（P =.01和.03）或无PI的患者相比显著升高（P =.02和.006）。然而，由于三组之间AST和ALT值有广泛重叠，转氨酶值在预测个体病例中PI的存在与否方面并无用处。术后第2至14天PI的发生与供体年龄较大相关（P =.06），但与0Pre活检结果、冷缺血时间或PT峰值无关。我们得出结论，0Post活检是预测术后早期后续PI的有价值工具。相比之下，0Pre活检结果以及AST和ALT峰值在评估PI方面并无用处。
