S-Space College of Medicine/School of Medicine (의과대학/대학원) Dept. of Medicine (의학과) Theses (Master's Degree_의학과)
Clinical Significance of Graft Fibrosis and Fatty Change Based on Late Protocol Liver Biopsy after Liver Transplantation
간이식 후 후기 프로토콜 조직검사에 기초한 이식편의 섬유화와 지방변화의 임상적 중요성
- 의과대학 의학과
- Issue Date
- 서울대학교 대학원
- 학위논문 (석사)-- 서울대학교 대학원 : 의학과 외과학 전공, 2013. 2. 서경석.
- Introduction: Little is known about the results of late protocol liver biopsy after LT yet, especially in aspect of graft fibrosis and fatty change. The aim of this study was to evaluate graft fibrosis and fatty change based on late protocol biopsy after LT, and to investigate possible relationships between clinical data and graft fibrosis or fatty change.
Patients and Methods: We retrospectively reviewed the recipients who underwent late protocol liver biopsy (> 1 year after LT) at our center between August 2010 and August 2012. Sono-guided fine needle aspiration liver biopsies and hematoxylin and eosin stains and Masson trichrome stains were performed. The METAVIR system for staging of graft fibrosis and the steatosis scoring system devised by the Pathology Committee of the NASH Clinical Research Network for fatty change grading were used. We analyzed the related peri-transplant clinical data and fibrosis or fatty change based on liver biopsy.
Results: Total 174 late protocol liver biopsies were done in 131 adult patients. Graft fibrosis was 23.6% (n = 41/174). Among them, significant (moderate and more) fibrosis was 46.3% (n = 19/41). In multivariate analysis between the group without fibrosis and the other group with fibrosis, based on the significant variables in univariate analysis, high mean fasting blood sugar (FBS, ≥ 126 mg/dL) during 6 months before biopsy regardless of treatment of DM (risk ratio 7.260, p = 0.001) and positive ductular reaction in CK-19 (risk ratio 7.931, p < 0.001) were significant factors for graft fibrosis after 1 year from LT. For significant fibrosis, positive ductular reaction in CK-19 (risk ratio 20.335, p < 0.001) and positive bile duct damage in CK-19 (risk ratio 17.351, p = 0.001) were strongly significant factors.
Fatty change showed in 25.3% (n = 44/174). Among them, significant change was 31.8% (n = 14/44). With multivariate analysis based on the significant variables in univariate analysis, male sex (risk ratio 3.448, p = 0.037), alcohol history before LT (risk ratio 5.755, p = 0.013), BMI ≥ 25 kg/m2 (risk ratio 2.926, p = 0.020) were clinically related factors for late graft fatty change. For significant fatty change, BMI ≥ 25 kg/m2 at biopsy showed significant difference (risk ratio 3.481, p = 0.037).
Conclusions: In conclusion, the graft fibrosis and fatty change based on late protocol biopsy after LT comprised a considerable portion. In this study, high mean FBS (≥ 126 mg/dL) during 6 months before biopsy regardless of treatment of DM and positive ductular reaction in CK-19 were closely related to the graft fibrosis, and male, alcohol history before LT and obesity (BMI ≥ 25 kg/m2) at biopsy were related to graft fatty change. We can apply these results to clinical management for recipients and that may be a good influence to future long-term outcome of the patients.