vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2022-4-118-123vtio-1571Research ArticleДонорство органовOrgan DonationПредикторы стеатоза у доноров печениPredictors of hepatic steatosis in living liver donorsМининаМ. Г.MininaM. G.

Москва

Moscow

minmar50@yahoo.comВороновД. В.VoronovD. V.

Москва

Moscow

НевредимовА АNevredimovA. A.

Москва

Moscow

ТенчуринаЭ. А.TenchurinaE. A.

Тенчурина Эльмира Анвяровна

125284, Москва, 2-й Боткинский пр-д, 5

Тел. (967) 113-87-64

Elmira Tenchurina

5, Vtoroy Botkinsky proezd, Moscow, 125284, Russian Federation

Phone: (967) 113-87-64

arimle@inbox.ruГБУЗ «Городская клиническая больница имени С.П. Боткина Департамента здравоохранения города Москвы», Московский городской координационный центр органного донорства; ФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава РоссииРоссияBotkin City Clinical Hospital; Shumakov National Medical Research Center of Transplantology and Artificial OrgansRussian FederationГБУЗ «Городская клиническая больница имени С.П. Боткина Департамента здравоохранения города Москвы», Московский городской координационный центр органного донорстваРоссияBotkin City Clinical HospitalRussian Federation202206102022244118123Copyright © Минина М.Г., Воронов Д.В., Невредимов А.А., Тенчурина Э.А., 20222022Минина М.Г., Воронов Д.В., Невредимов А.А., Тенчурина Э.А.Minina M.G., Voronov D.V., Nevredimov A.A., Tenchurina E.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/1571

Стеатоз рассматривается как фактор риска при трансплантации донорской печени. Макростеатоз (>50%) ассоциируется с первичной дисфункцией трансплантата и может вызывать снижение долгосрочной выживаемости реципиентов.

Цель исследования

Цель исследования: выявить предикторы макровезикулярного стеатоза печени (>50%) путем анализа характеристик донора.

Материалы и методы

Материалы и методы. В ретроспективное исследование вошли 525 потенциальных доноров печени в период с 1 января 2019 года по 31 декабря 2020 года. Исследование клинико-морфологических характеристик доноров выполнено с использованием логистической регрессии и ROC-анализа. Пороговые значения показателей, продемонстрировавших статистическую достоверность в мультивариантном анализе в качестве предикторов стеатоза печени >50%, получены посредством ROC-анализа на основании расчета оптимальной точки отсечения.

Результаты

Результаты. Сахарный диабет, причина смерти донора (черепно-мозговая травма), а также значения показателей АЛТ >90 ед/л, АСТ >110 ед/л явились предикторами стеатоза >50%, выявленного по данным нулевой биопсии у донора. Практически идентичные показатели чувствительности и специфичности определены в ROC-анализе у ферментов печени – АЛТ, АСТ, составившие 69,1; 80,6 и 72,2; 81,1 соответственно. С учетом полученных значений, мы можем говорить, что при повышении уровня ферментов печени в крови донора с высокой степенью вероятности следует ожидать повреждения паренхимы печени, но невысокий уровень чувствительности указывает на возможную многофакторность повреждения печени, и одним из факторов может быть стеатоз, но может наблюдаться и отсутствие какого-либо повреждения паренхимы. Вместе с тем достаточно высокая специфичность, выявленная в ROC-анализе для ферментов печени, является достоверным признаком отсутствия стеатоза при значениях ферментов меньше пороговых.

Заключение

Заключение. Пороговые значения, установленные для АЛТ, АСТ, и соответствующие им уровни чувствительности и специфичности указывают на относительно невысокий прогностический уровень данных показателей в контексте наличия у донора выраженного стеатоза, что позволяет, тем не менее, использовать модели, построенные на их основе, в качестве скрининговых при первичной оценке доноров печени.

Fatty liver disease (steatosis) is considered a risk factor in donor liver transplantation (LT). Macrosteatosis (>50%) is associated with primary graft dysfunction and may reduce long-term recipient survival.

Objective

Objective: to identify predictors of macrovesicular steatosis (>50%) by analyzing donor characteristics.

Materials and methods

Materials and methods. The retrospective study included 525 potential liver donors between January 1, 2019 and December 31, 2020. Clinical and morphological characteristics of donors were studied using logistic regression and receiver operating characteristic (ROC) analysis. Threshold values of parameters demonstrating statistical significance in multivariate analysis as predictors of >50% hepatic steatosis were obtained by ROC analysis based on calculation of the optimal cutoff point.

Results

Results. Diabetes mellitus (DM), cause of donor’s death (traumatic brain injury), alanine transaminase (ALT) >90 units/L and aspartate transaminase (AST) >110 units/L were predictors of >50% steatosis, revealed by time-zero biopsy in the donor. Almost identical sensitivity and specificity indicators were determined in ROC analysis for liver enzymes – ALT and AST – which were 69.1 and 80.6; 72.2 and 81.1, respectively. Given the obtained values, we can say that with elevated levels of liver enzymes in the donor’s blood, there is a high degree of probability of liver parenchymal damage, but low sensitivity indicates possible multifactoriality of liver damage, and fatty liver disease may be one of the factors, but there may also be no damage to the liver parenchyma. At the same time, the rather high specificity revealed in ROC analysis for liver enzymes is a reliable sign of the absence of fatty liver disease at enzyme values less than the threshold.

Conclusion

Conclusion. The thresholds established for ALT and AST and their corresponding levels of sensitivity and specificity indicate that these parameters have a relatively low predictive level in the context of the presence of severe fatty liver disease in a donor. This allows, nevertheless, to use models built on their basis as screening models in the primary evaluation of liver donors.

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The authors declare that there are no conflicts of interest present.