铁超载是否与接受肝移植的慢性肝病患者的不良预后有关?

Sergio Rodriguez-Rodriguez, Antonio Olivas-Martinez, Jesus Delgado-de la Mora, Braulio Martinez-Benitez, Ignacio Garcia-Juarez, Roberta Demichelis-Gomez
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引用次数: 0

摘要

背景:铁超载在慢性肝病患者中很常见,与遗传性血色病患者肝移植后存活期缩短有关。它对非遗传性血色病患者的影响尚不清楚。本研究旨在研究铁超载对在一家学术性三级转诊中心接受肝移植的患者的临床影响:我们进行了一项回顾性队列研究,研究对象包括2015年至2017年在墨西哥城一家学术性三级转诊中心接受肝移植手术的所有非遗传性血色病患者。对肝脏活组织切片进行再处理,以获得组织化学肝铁指数,将得分≥ 0.15 视为铁超载。比较了铁超载和非铁超载患者的基线特征。采用 Kaplan-Meier 法估算生存率,并与对数秩检验和 Cox 比例危险模型进行比较:结果:在纳入的 105 名患者中,45% 存在铁超载。与铁超载患者相比,铁超载患者中病毒和代谢病因、饮酒和肥胖的发病率更高(分别为 43% 对 21%、32% 对 22%,p = 0.011;34% 对 9%,p = 0.001;32% 对 12%,p = 0.013)。8名患者在肝移植后90天内死亡(其中1人铁负荷过重)。铁超载患者的并发症发生率高于非铁超载患者(223例/100人月对93例/100人月;发生任何并发症的中位时间为2天对3天,p = 0.043),但并发症类型无差异。铁超载患者的死亡率低于非铁超载患者(0.7 对 4.5,P = 0.055):结论:检测铁超载可识别肝移植后有早期并发症风险的患者。结论:检测铁超载可能会发现肝移植后有早期并发症风险的患者,需要进一步研究以了解铁超载在存活率中的作用。
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Is iron overload associated with worse outcomes in patients with chronic liver disease undergoing liver transplantation?

Background: Iron overload is frequent in patients with chronic liver disease, associated with shorter survival after liver transplantation in patients with hereditary hemochromatosis. Its effect on patients without hereditary hemochromatosis is unclear. The aim of the study was to study the clinical impact of iron overload in patients who underwent liver transplantation at an academic tertiary referral center.

Methods: We performed a retrospective cohort study including all patients without hereditary hemochromatosis who underwent liver transplantation from 2015 to 2017 at an academic tertiary referral center in Mexico City. Explant liver biopsies were reprocessed to obtain the histochemical hepatic iron index, considering a score ≥ 0.15 as iron overload. Baseline characteristics were compared between patients with and without iron overload. Survival was estimated using the Kaplan-Meier method, compared with the log-rank test and the Cox proportional hazards model.

Results: Of 105 patients included, 45% had iron overload. Viral and metabolic etiologies, alcohol consumption, and obesity were more frequent in patients with iron overload than in those without iron overload (43% vs. 21%, 32% vs. 22%, p = 0.011; 34% vs. 9%, p = 0.001; and 32% vs. 12%, p = 0.013, respectively). Eight patients died within 90 days after liver transplantation (one with iron overload). Complication rate was higher in patients with iron overload versus those without iron overload (223 vs. 93 events/100 personmonths; median time to any complication of 2 vs. 3 days, p = 0.043), without differences in complication type. Fatality rate was lower in patients with iron overload versus those without iron overload (0.7 vs. 4.5 deaths/100 person-months, p = 0.055).

Conclusion: Detecting iron overload might identify patients at risk of early complications after liver transplantation. Further studies are required to understand the role of iron overload in survival.

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来源期刊
CiteScore
3.00
自引率
0.00%
发文量
60
审稿时长
>12 weeks
期刊介绍: The Revista de Investigación Clínica – Clinical and Translational Investigation (RIC-C&TI), publishes original clinical and biomedical research of interest to physicians in internal medicine, surgery, and any of their specialties. The Revista de Investigación Clínica – Clinical and Translational Investigation is the official journal of the National Institutes of Health of Mexico, which comprises a group of Institutes and High Specialty Hospitals belonging to the Ministery of Health. The journal is published both on-line and in printed version, appears bimonthly and publishes peer-reviewed original research articles as well as brief and in-depth reviews. All articles published are open access and can be immediately and permanently free for everyone to read and download. The journal accepts clinical and molecular research articles, short reports and reviews. Types of manuscripts: – Brief Communications – Research Letters – Original Articles – Brief Reviews – In-depth Reviews – Perspectives – Letters to the Editor
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