Clinical Significance of Grade A Small-for-size Syndrome After Living Donor Liver Transplantation Utilizing the New Definition of Diagnostic Criteria: An International Multicenter Study.

IF 5.3 2区 医学 Q1 IMMUNOLOGY Transplantation Pub Date : 2025-02-01 Epub Date: 2024-10-08 DOI:10.1097/TP.0000000000005225
Hye-Sung Jo, Dong-Sik Kim, Vasanthakumar Gunasekaran, Jagadeesh Krishnamurthy, Takeo Toshima, Ryugen Takahashi, Jae-Yoon Kim, Sathish Kumar Krishnan, Shinya Okumura, Takanobu Hara, Keita Shimata, Koichiro Haruki, Robert C Minnee, Ashwin Rammohan, Subash Gupta, Tomoharu Yoshizumi, Toru Ikegami, Kwang-Woong Lee, Mohamed Rela
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Abstract

Background: New diagnostic criteria have recently been established to classify small-for-size syndrome (SFSS) after living donor liver transplantation into 3 groups based on severity. This study aimed to evaluate the clinical impact of grade A SFSS and identify the mortality risk.

Methods: We collected data from 406 patients diagnosed with grade A SFSS after living donor liver transplantation. Grade A SFSS is characterized by total bilirubin >5 mg/dL on postoperative day (POD) 7 or total bilirubin >5 mg/dL or ascites >1 L/d on POD 14. After propensity score matching, 193 patients were categorized into the up-trend group, down-trend group, and ascites group, with 43 patients (22.3%) in the up-trend group (total bilirubin on POD 7 < POD 14), 107 patients (55.4%) in the down-trend group (total bilirubin on POD 7 > POD 14), and 43 patients (22.3%) in the ascites group (only satisfying ascites criteria).

Results: There was no significant difference in survival between patients with grade A SFSS and those without SFSS ( P  = 0.152). The up-trend group showed a higher 90-d mortality rate than the down-trend and ascites groups ( P  = 0.025). The 1-y survival rate differed significantly between the groups (87.6%, 91.9%, and 97.7%, respectively; P  = 0.044). The independent risk factors for survival were up-trend of total bilirubin, recipient age (65 y and older), model for end-stage liver disease score (≥30), and ABO incompatibility. Patients with ≥2 risk factors had worse survival rates than those with none and only 1 risk factor ( P  < 0.001).

Conclusions: Although the survival rate was comparable between the grade A SFSS and non-SFSS cohorts, the up-trend group showed worse survival. Aggressive interventions should be considered for up-trend patients with risk factors.

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采用新诊断标准定义的活体肝移植后 A 级小肝综合征的临床意义:一项国际多中心研究。
背景:最近制定了新的诊断标准,根据严重程度将活体肝移植后的小体综合征(small-for-size syndrome,SFSS)分为三组。本研究旨在评估 A 级 SFSS 的临床影响,并确定其死亡风险:我们收集了406例活体肝移植后确诊为A级SFSS患者的数据。A 级 SFSS 的特征是术后第 7 天(POD)总胆红素大于 5 mg/dL,或术后第 14 天(POD)总胆红素大于 5 mg/dL 或腹水大于 1 L/d。经过倾向评分匹配后,193 名患者被分为上升趋势组、下降趋势组和腹水组,其中 43 名患者(22.3%)属于上升趋势组(POD 7 的总胆红素 < POD 14),107 名患者(55.4%)属于下降趋势组(POD 7 的总胆红素 > POD 14),43 名患者(22.3%)属于腹水组(仅满足腹水标准):A 级 SFSS 患者与无 SFSS 患者的生存率无明显差异(P = 0.152)。上行趋势组的 90 天死亡率高于下行趋势组和腹水组(P = 0.025)。各组的 1 年生存率差异显著(分别为 87.6%、91.9% 和 97.7%;P = 0.044)。总胆红素呈上升趋势、受者年龄(65 岁及以上)、终末期肝病模型评分(≥30 分)和 ABO 不相容是影响存活率的独立危险因素。有≥2个风险因素的患者的生存率比没有和只有1个风险因素的患者差(P 结论:≥2个风险因素的患者的生存率比没有和只有1个风险因素的患者差):虽然A级SFSS组和非SFSS组的生存率相当,但上升趋势组的生存率更差。对于有危险因素的上升趋势患者,应考虑采取积极的干预措施。
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来源期刊
Transplantation
Transplantation 医学-免疫学
CiteScore
8.50
自引率
11.30%
发文量
1906
审稿时长
1 months
期刊介绍: The official journal of The Transplantation Society, and the International Liver Transplantation Society, Transplantation is published monthly and is the most cited and influential journal in the field, with more than 25,000 citations per year. Transplantation has been the trusted source for extensive and timely coverage of the most important advances in transplantation for over 50 years. The Editors and Editorial Board are an international group of research and clinical leaders that includes many pioneers of the field, representing a diverse range of areas of expertise. This capable editorial team provides thoughtful and thorough peer review, and delivers rapid, careful and insightful editorial evaluation of all manuscripts submitted to the journal. Transplantation is committed to rapid review and publication. The journal remains competitive with a time to first decision of fewer than 21 days. Transplantation was the first in the field to offer CME credit to its peer reviewers for reviews completed. The journal publishes original research articles in original clinical science and original basic science. Short reports bring attention to research at the forefront of the field. Other areas covered include cell therapy and islet transplantation, immunobiology and genomics, and xenotransplantation. ​
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