留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

自身免疫性肝病与病毒性肝炎肝硬化肝移植预后差异配对分析

宋占宇 潘崎 于杨 贾德功 刘永锋

宋占宇, 潘崎, 于杨, 等. 自身免疫性肝病与病毒性肝炎肝硬化肝移植预后差异配对分析[J]. 器官移植, 2020, 11(1): 82-86. doi: 10.3969/j.issn.1674-7445.2020.01.013
引用本文: 宋占宇, 潘崎, 于杨, 等. 自身免疫性肝病与病毒性肝炎肝硬化肝移植预后差异配对分析[J]. 器官移植, 2020, 11(1): 82-86. doi: 10.3969/j.issn.1674-7445.2020.01.013
Song Zhanyu, Pan Qi, Yu Yang, et al. Pairing analysis of clinical prognosis between liver transplantation with autoimmune liver disease and viral hepatitis cirrhosis[J]. ORGAN TRANSPLANTATION, 2020, 11(1): 82-86. doi: 10.3969/j.issn.1674-7445.2020.01.013
Citation: Song Zhanyu, Pan Qi, Yu Yang, et al. Pairing analysis of clinical prognosis between liver transplantation with autoimmune liver disease and viral hepatitis cirrhosis[J]. ORGAN TRANSPLANTATION, 2020, 11(1): 82-86. doi: 10.3969/j.issn.1674-7445.2020.01.013

自身免疫性肝病与病毒性肝炎肝硬化肝移植预后差异配对分析

doi: 10.3969/j.issn.1674-7445.2020.01.013
基金项目: 

辽宁省教育厅重点实验室项目 LS201603

详细信息
    作者简介:

    宋占宇,男,1992年生,硕士研究生, 研究方向为器官移植,Email:1422383698@qq.com

    通讯作者:

    刘永锋,男,1952年生,博士研究生导师,教授,研究方向为器官移植,Email: gdwkkyxx@sina.com

  • 中图分类号: R617, R657.3+1

Pairing analysis of clinical prognosis between liver transplantation with autoimmune liver disease and viral hepatitis cirrhosis

More Information
  • 摘要:   目的  分析自身免疫性肝病(AILD)与病毒性肝炎肝硬化肝移植的预后差异及预后影响因素。  方法  回顾性分析2002年1月至2017年1月行肝移植的75例受者临床资料。将受者分为AILD组(25例)和病毒性肝炎肝硬化组(50例)。观察受者的术中情况,包括器官热缺血时间、冷缺血时间、手术时间、无肝期、输血量; 观察术后并发症发生情况,包括重度急性肾损伤(AKI)、感染、急性排斥反应、胆道相关并发症、血管相关并发症、移植后糖尿病(PTDM); 观察出院后随访情况。分析肝移植受者预后的影响因素。  结果  AILD组与病毒性肝炎肝硬化组的器官热缺血时间、冷缺血时间、手术时间、无肝期比较,差异均无统计学意义(均为P > 0.05)。AILD组受者术后急性排斥发生率高于病毒性肝炎肝硬化组受者(P < 0.05),术后重度AKI发生率低于病毒性肝炎肝硬化组受者(P < 0.05)。AILD组术后1、3、5年生存率分别为92%、87%、87%,病毒性肝炎肝硬化组术后1、3、5年生存率88%、88%、88%,两组受者累积生存率的差异均无统计学意义(均为P > 0.05)。单因素分析结果显示年龄、终末期肝病模型(MELD)评分、重度AKI、感染、胆道相关并发症等5个指标是受者预后的影响因素(均为P < 0.05)。  结论  AILD组和病毒性肝炎肝硬化组受者移植术后总体生存预后无明显差异,年龄、MELD评分、重度AKI、感染、胆道相关并发症是影响肝移植预后风险因素。

     

  • 图  1  两组受者肝移植术后5年内的生存曲线

    Figure  1.  Survival curves of recipients within 5 years after liver transplantation in 2 groups

    表  1  两组受者肝移植术后并发症发生情况

    Table  1.   Complications of recipients after liver transplantation in 2 groups [n(%)]

    组别 n 重度AKI 感染 急性排斥反应 胆道相关并发症 血管相关并发症 PTDM
    AILD组 25 0(0) 11(44) 12(48) 7(28) 4(16) 5(20)
    病毒性肝炎肝硬化组 50 8(16) 20(40) 10(20) 9(18) 9(18) 6(12)
    P 0.034 0.740 0.012 0.319 0.829 0.356
    下载: 导出CSV
  • [1] 谭立明, 吴思凡, 郑葳, 等.自身免疫性肝病合并血管炎患者检测ANCA、IgG4的潜在价值[J].实用医学杂志, 2018, 34(14):2410-2415. DOI: 10.3969/j.issn.1006-5725.2018.14.032.

    TAN LM, WU SF, ZHENG W, et al. Potential value of detection of ANCA and IgG4 in autoimmune liverdisease complicated with vasculitis[J]. J Pract Med, 2018, 34(14):2410-2415.DOI:10.3969/j.issn.1006-5725. 2018.14.032.
    [2] ARNDTZ K, HIRSCHFIELD GM. The pathogenesis of autoimmune liver disease[J]. Dig Dis, 2016, 34(4):327-333. DOI: 10.1159/000444471.
    [3] 邹游, 张磊, 李瑞东, 等.肝移植治疗终末期自身免疫性肝病的预后分析[J].器官移植, 2014, 5(4):222-226. DOI: 10.3969/j.issn.1674-7445.2014.04.006.

    ZOU Y, ZHANG L, LI RD, et al. Prognostic analysis of liver transplantation in treating patients with end-stageautoimmune liver disease[J]. Organ Transplant, 2014, 5(4):222-226. DOI:10.3969/j.issn.1674-7445. 2014.04.006.
    [4] 帅鸣琪, 耿磊, 严盛, 等.肝移植治疗终末期自身免疫性肝病的预后分析[J].中华器官移植杂志, 2015, 36(8):486-489.DOI: 10.3760/cma.j.issn.0254-1785.2015.08.009.

    SHUAI MQ, GENG L, YAN S, et al. A prognostic analysis of liver transplantation in treating endstage autoimmune liver disease[J]. Chin J Organ Transplant, 2015, 36(8):486-489. DOI: 10.3760/cma.j.issn.0254-1785.2015.08.009.
    [5] ZHONG CP, XI ZF, XIA Q. Clinical analysis of liver transplantation in autoimmune liver diseases[J]. Hepatobiliary Pancreat Dis Int, 2018, 17(1):27-31. DOI: 10.1016/j.hbpd.2018.01.001.
    [6] 中华医学会肝病学分会, 中华医学消化病学分会, 中华医学会感染病学分会.原发性硬化性胆管炎诊断和治疗专家共识(2015)[J].中华传染病杂志, 2016, 34(8):449-458.DOI: 10.3760/cma.j.issn.1000-6680.2016.08.001.

    Branch of Hepatology of Chinese Medical Association, Branch of Gastroenterology of Chinese Medical Association, Branch of Infectious Diseases of Chinese Medical Association. Expert consensus on diagnosis and treatment of primary sclerosing cholangitis (2015)[J]. Chin J Infect Dis, 2016, 34(8):449-458. DOI: 10.3760/cma.j.issn.1000-6680.2016.08.001.
    [7] VANDERLOCHT J, VAN DER CRUYS M, STALS F, et al. Multiplex autoantibody detection for autoimmune liver diseases and autoimmune gastritis[J]. J ImmunolMethods, 2017, 448:21-25. DOI: 10.1016/j.jim.2017.05. 003.
    [8] SAMUEL D, SANCHEZ-FUEYO A. Immunotherapy in liver transplantation[J]. J Hepatol, 2017, 67(4):874-875. DOI: 10.1016/j.jhep.2017.05.013.
    [9] KHWAJA A. KDIGO clinical practice guidelines for acute kidney injury[J]. Nephron Clin Pract, 2012, 120(4):c179-c184. DOI: 10.1159/000339789.
    [10] SHARIF A, HECKING M, DE VRIES AP, et al. Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions[J]. Am J Transplant, 2014, 14(9):1992-2000. DOI: 10.1111/ajt.12850.
    [11] RODRÍGUEZ-PERÁLVAREZ M, RICO-JURI JM, TSOCHATZIS E, et al. Biopsy-proven acute cellular rejection as an efficacy endpoint of randomized trials in liver transplantation: a systematic review and critical appraisal[J]. Transpl Int, 2016, 29(9):961-973. DOI: 10.1111/tri.12737.
    [12] DEMETRIS AJ, BELLAMY C, HÜBSCHER SG, et al. 2016 comprehensive update of the banff working group on liver allograft pathology: introduction of antibody-mediated rejection[J]. Am J Transplant, 2016, 16(10):2816-2835. DOI: 10.1111/ajt.13909.
    [13] VEERAPPAN A, VANWAGNER LB, MATHEW JM, et al. Low incidence of acute rejection in hepatitis B virus positive liver transplant recipients and the impact of hepatitis B immunoglobulin[J]. Hum Immunol, 2016, 77(4):367-374. DOI: 10.1016/j.humimm.2016.02.009.
    [14] DURAND F, FRANCOZ C, ASRANI SK, et al. Acute kidney injury after liver transplantation[J]. Transplantation, 2018, 102(10):1636-1649. DOI: 10.1097/TP.0000000000002305.
    [15] UMBRO I, TINTI F, SCALERA I, et al. Acute kidneyinjury and post-reperfusion syndrome in liver transplantation[J]. World J Gastroenterol, 2016, 22(42): 9314-9323. doi: 10.3748/wjg.v22.i42.9314
    [16] BARRETO AG, DAHER EF, SILVA JUNIOR GB, et al. Risk factors for acute kidney injury and 30-day mortality after liver transplantation[J]. Ann Hepatol, 2015, 14(5):688-694. doi: 10.1016/S1665-2681(19)30763-X
    [17] SENTER-ZAPATA M, KHAN AS, SUBRAMANIAN T, et al. Patient and graft survival: biliary complicationsafter liver transplantation[J]. J Am Coll Surg, 2018, 226(4):484-494. DOI: 10.1016/j.jamcollsurg.2017.12.039.
    [18] LAICI C, GAMBERINI L, BARDI T, et al. Early infections in the intensive care unit after liver transplantation-etiology and risk factors: a single-center experience[J]. Transpl Infect Dis, 2018, 20(2):e12834. DOI: 10.1111/tid.12834.
    [19] JADLOWIEC CC, TANER T. Liver transplantation: current status and challenges[J]. World J Gastroenterol, 2016, 22(18):4438-4445. DOI: 10.3748/wjg.v22.i18.4438.
    [20] LIBERAL R, ZEN Y, MIELI-VERGANI G, et al. Liver transplantation and autoimmune liver diseases[J]. Liver Transpl, 2013, 19(10):1065-1077. DOI: 10.1002/lt.23704.
    [21] MONTANO-LOZA AJ, BHANJI RA, WASILENKO S, et al. Systematic review: recurrent autoimmune liver diseases after liver transplantation[J]. Aliment Pharmacol Ther, 2017, 45(4):485-500. DOI: 10.1111/apt.13894.
    [22] BOSCH A, DUMORTIER J, MAUCORT-BOULCH D, et al. Preventive administration of UDCA after liver transplantation for primary biliary cirrhosis is associated with a lower risk of disease recurrence[J]. J Hepatol, 2015, 63(6):1449-1458. DOI: 10.1016/j.jhep.2015.07.038.
    [23] CHARATCHAROENWITTHAYA P, PIMENTEL S, TALWALKAR JA, et al. Long-term survival and impact of ursodeoxycholic acid treatment for recurrent primary biliary cirrhosis after liver transplantation[J]. Liver Transpl, 2007, 13(9):1236-1245. doi: 10.1002/lt.21124
  • 加载中
图(1) / 表(1)
计量
  • 文章访问数:  137
  • HTML全文浏览量:  57
  • PDF下载量:  9
  • 被引次数: 0
出版历程
  • 收稿日期:  2019-10-15
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2020-01-15

目录

    /

    返回文章
    返回