ABSTRACT
Objective:To explore the poor early liver graft function(PEGF)-related biomarkers and establish a genomic model for PEGF prediction specific to liver transplantation(LT)with allografts of donation after brain death(DBD).Methods:By data-mining a public GSE23649 dataset from the database of Gene Expression Omnibus(GEO), key PEGF-related genes in DBD liver biopsies after 2h reperfusion were identified by differential expression analysis.And LASSO-penalized Logistic regression model was utilized for selecting an optimal gene set.Receiver operating characteristic curves with its area under the curve(AUC)and a nomogram were generated for evaluating and visualizing its predictive capability for PEGF.Gene set enrichment analysis(GSEA) was performed for exploring the biological pathways underlying PEGF.Results:Six key PEGF-related genes in DBD-LT were initially identified, including 4 up-regulated genes(HBB, PFDN5, RPS3A & RPS5)and 2 down-regulated genes(RPL22 & FAM62B). A six-mRNA-based risk-scoring model was further established with an excellent predictive capability(AUC=1.000, P=0.0008). Four PEGF-related biological pathways in DBD livers, such as "VEGF" and "natural killer cell-mediated cytotoxicity" , were identified by GSEA(all P<0.05). Conclusions:The genomic model may effectively predict the likelihood of PEGF immediately after DBD-LT or even prior to transplantation in the context of normothermic machine perfusion.
ABSTRACT
Objective To investigate the effect of low platelet (PLT) count on the early fatality rate of liver transplant recipients without intraoperative PLT transfusion. Methods Clinical data of 180 recipients undergoing orthotopic liver transplantation were retrospectively analyzed. The critical value of PLT count on postoperative 7 d to predict the early postoperative fatality rate was evaluated by the receiver operating characteristic(ROC) curve. All recipients were divided into the low PLT count group and control group according to the critical value. Relevant clinical data including perioperative PLT count, preoperative general conditions and intraoperative conditions of the recipients were included. The independent risk factors of the early fatality rate of liver transplant recipients were analyzed by Logistic regression analysis. The early prognosis of the recipients between two groups was observed and compared by the postoperative length of intensive care unit (ICU) stay, postoperative length of hospital stay, early allograft dysfunction and fatality rate on postoperative 30 d. Results The PLT count < 32×109/L on 7 d after liver transplantation was an independent risk factor of the fatality rate on postoperative 30 d (P < 0.05). The postoperative length of ICU stay of the recipients in the low PLT count group was 9 (5, 14) d, significantly longer than 5 (3, 6) d in the control group (P < 0.05). In the low PLT count group, the early allograft dysfunction rate was 55.0%, significantly higher than 20.6% in the control group (P < 0.05). In the low PLT count group, the fatality rate on postoperative 30 d was 40.0%, significantly higher than 2.5% in the control group (P < 0.05). The length of hospital stay did not significantly differ between two groups (P > 0.05). Conclusions The PLT count < 32×109/L on postoperative 7 d is an independent risk factor for the fatality rate on postoperative 30 d of liver transplant recipients. It can prompt the early allograft dysfunction and contribute to predict the early clinical prognosis of liver transplant recipients.
