Donor liver apoptosis is associated with early allograft dysfunction and decreased short-term graft survival after liver transplantation.
BACKGROUND:The clinical significance of apoptosis in assessing the quality of donor liver grafts remains unknown. AIMS:This study aimed to determine whether apoptosis in a donor liver is predictive of early allograft dysfunction (EAD) and graft survival after liver transplantation (LT). METHODS:Donor liver specimens were analyzed for apoptosis using TUNEL assays. The prognostic factors for EAD were identified through logistic regression analyses, and a nomogram was developed. RESULTS:The apoptosis index of donor livers in EAD patients was significantly higher than that of donors livers in non-EAD patients (median 5.3; interquartile range [IQR] 3.4 vs 3.5; 3.6, P < 0.001). Multivariate analyses identified the apoptosis index of the donor liver (HR = 6.927, P < 0.001) and five other characteristics as independent predictors of EAD. A nomogram built on these predictive variables showed good calibration and discriminatory abilities, with a c-index value of 0.847. The 30-day graft survival rates in the high apoptosis index (apoptosis index >4.4%) group were significantly lower than those in the low apoptosis index (apoptosis index ≤4.4%) group (84.4% vs 97.6%, P = 0.004). CONCLUSIONS:Donor liver apoptosis plays a significant role in predicting EAD after LT. Furthermore, a high apoptosis index in the donor liver was associated with inferior graft survival in the short-term.
Zhu, Z; Tang, Y; Huang, S; Zhao, Q; Schroder, PM; Zhang, Z; Zhang, Y; Sun, C; Wang, L; Ju, W; Wang, D; Guo, Z; He, X
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