Risk factors for allograft failure in liver transplant recipients

Anna Huesing-Kabar; Christina zu Dohna; Hauke Heinzow; Vito Rosario Cicinnati; Susanne Beckebaum; Martina Schmidt; Hans Ulrich Gerth; Michele Pohlen; Christian Wilms; Daniel Palmes; Hartmut Hans-Jürgen Schmidt; Iyad Kabar

doi:10.1055/s-0043-125225

Zeitschrift für Gastroenterologie, Inhaltsverzeichnis

Z Gastroenterol 2018; 56(07): 745-751
DOI: 10.1055/s-0043-125225

Originalarbeit

Risk factors for allograft failure in liver transplant recipients

Graft failure after liver transplantationRisikofaktoren einer Transplantatdysfunktion nach LebertransplantationTransplantatdysfunktion nach Lebertransplantation

Anna Huesing-Kabar

¹University Hospital Muenster, Department of Medicine B, Gastroenterology and Hepatology, Muenster, Germany

,

Christina zu Dohna

¹University Hospital Muenster, Department of Medicine B, Gastroenterology and Hepatology, Muenster, Germany

,

Hauke Heinzow

¹University Hospital Muenster, Department of Medicine B, Gastroenterology and Hepatology, Muenster, Germany

,

Vito Rosario Cicinnati

¹University Hospital Muenster, Department of Medicine B, Gastroenterology and Hepatology, Muenster, Germany

,

Susanne Beckebaum

¹University Hospital Muenster, Department of Medicine B, Gastroenterology and Hepatology, Muenster, Germany

,

Martina Schmidt

¹University Hospital Muenster, Department of Medicine B, Gastroenterology and Hepatology, Muenster, Germany

,

Hans Ulrich Gerth

²University Hospital Muenster, Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, Muenster, Germany

,

Michele Pohlen

³University Hospital Muenster, Department of Medicine A, Hematology and Oncology, Muenster, Germany

,

Christian Wilms

¹University Hospital Muenster, Department of Medicine B, Gastroenterology and Hepatology, Muenster, Germany

,

Daniel Palmes

⁴University Hospital Muenster, Department of General and Visceral Surgery, Muenster, Germany

,

Hartmut Hans-Jürgen Schmidt

¹University Hospital Muenster, Department of Medicine B, Gastroenterology and Hepatology, Muenster, Germany

,

Iyad Kabar

¹University Hospital Muenster, Department of Medicine B, Gastroenterology and Hepatology, Muenster, Germany

› Institutsangaben

Abstract

Background With regard to quality of life and organ shortage, follow-up after liver transplantation (LT) should consider risk factors for allograft failure in order to avoid the need for re-LT and to improve the long-term outcome of recipients. Therefore, the aim of this study was to explore potential risk factors for allograft failure after LT.

Material and methods A total of 489 consecutive LT recipients who received follow-up care at the University Hospital of Muenster were included in this study. Database research was performed, and patient data were retrospectively reviewed. Risk factors related to donor and recipient characteristics potentially leading to allograft failure were statistically investigated using binary logistic regression analysis. Graft failure was determined as graft cirrhosis, need for re-LT because of graft dysfunction, and/or allograft-associated death.

Results The mean age of recipients at the time of LT was 50.3 ± 12.4 years, and 64.0 % were male. The mean age of donors was 48.7 ± 15.5 years. Multivariable statistical analysis revealed male recipient gender (p = 0.04), hepatitis C virus infection (HCV) (p = 0.014), hepatocellular carcinoma (HCC) (p = 0.03), biliary complications after LT (p < 0.001), pretransplant diabetes mellitus (p = 0.03), and/or marked fibrosis in the initial protocol biopsy during follow-up (p = 0.001) to be recipient-related significant and independent risk factors for allograft failure following LT.

Conclusion Male recipients, patients who received LT for HCV or HCC, those with pretransplant diabetes mellitus, and LT recipients with biliary complications are at high risk for allograft failure and thus should be monitored closely.

Zusammenfassung

Hintergrund Im Hinblick auf die Lebensqualität und den herrschenden Organmangel sollte die Nachsorge nach einer Lebertransplantation (LT) Risikofaktoren für eine Transplantatdysfunktion berücksichtigen, um sowohl die Langzeitergebnisse zu verbessern als auch Retransplantationen zu vermeiden. Ziel dieser Studie war es daher Risikofaktoren für ein Organversagen nach einer LT zu evaluieren.

Methoden 489 lebertransplantierte Patienten wurden konsekutiv in diese retrospektive Studie eingeschlossen. Es wurde eine Datenbankrecherche durchgeführt. Mittels einer binären Regressionsanalyse wurden potentielle Risikofaktoren eines Transplantatversagens nach einer LT ermittelt. Als Transplantatversagen wurden eine Transplantatzirrhose, die Notwendigkeit einer Re-LT und der transplantatassoziierte Tod definiert.

Ergebnisse Das mittlere LT-Empfängeralter lag bei 50,3 ± 12,4 Jahren. 64 % der Empfänger waren männlich. Das Spenderalter lag bei 48,7 ± 15,5 Jahren. Die statistische Analyse ergab folgende unabhängige Risikofaktoren für ein Transplantatversagen: männliches Empfängergeschlecht (p = 0,04), Hepatitis-C-Virus-Infektion (HCV) (p = 0,014) und hepatozelluläres Karzinom (HCC) (p = 0,03) als Grunderkrankung, Prätransplantationsdiabetes (p = 0,03) sowie biliäre Komplikationen (p < 0,001) und/oder deutliche Fibrose in der Protokoll-Biopsie während der Nachsorgezeit (p = 0,001).

Schlussfolgerung Männliche Empfänger, Patienten mit HCV bzw. HCC als Grunderkrankungen, solche mit Prätransplantationsdiabetes sowie LT-Empfänger mit biliären Komplikationen haben ein erhöhtes Risiko für ein Transplantatversagen und sollten daher speziell hinsichtlich dieser Risikofaktoren nachgesorgt werden.

Schlüsselwörter

Lebertransplantation - Transplantatdysfunktion - Biliäre Komplikationen - Ischämiezeit - Immunsuppression - Langzeitüberleben nach Lebertransplantation - Geschlechterunübereinstimmung - hepatozelluläres Karzinom - Hepatitis C

Key words

liver transplantation - graft failure - biliary complications - ischemia time - immunosuppression - long-term outcome of liver transplantation - gender mismatch - HCC - HCV

Volltext

Referenzen

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