Genetic, immunological and clinical risk factors for biliary strictures following liver transplantation

Liver International - Tập 32 Số 8 - Trang 1253-1261 - 2012
Marc G. Genton1,2,3, Vito R. Cicinnati1,2, Alexander Dechêne2, Monika Lindemann4, Falko M. Heinemann4, Vera Rebmann4, S. Ferenčík5, Georgios C. Sotiropoulos1, Irinel Popescu3, Peter A. Horn4, Guido Gerken2, Andreas Paul1, Susanne Beckebaum1,2
1Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Essen, Germany
2Departments of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
3Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation, Bucharest, Romania
4Institute for Transfusion Medicine, University Hospital Essen, Essen, Germany
5Institute for Immunology, University Hospital Essen Essen Germany

Tóm tắt

AbstractBackgroundBiliary strictures after liver transplantation (LT) are a major cause of morbidity and reduced graft survival.AimsThe purpose of this study was to investigate genetic, immunological and clinical risk factors for the occurrence of post‐LT ischaemic type biliary lesions (ITBLs) and biliary anastomotic strictures (AS).MethodsClinical and laboratory data, chemokine receptor (CCR) genotypes, chemotactic cytokines and anti‐major‐histocompatibility complex antibodies in serum were investigated in 162 LT patients.ResultsIn the univariate analysis, older donor and recipient age, partial LT, high peak aspartate aminotransaminase (AST) levels and CC chemokine receptor 5 delta32 loss‐of‐function mutation (CCR5Δ32) were associated with ITBL, whereas LT for acute liver failure (ALF), ABO‐compatible non‐identical LT, presence of donor‐specific anti‐human leucocyte antigen (HLA) class II antibodies and fractalkine receptor (CX3CR1)‐249II allele were associated with AS. In the multivariate analysis, CCR5Δ32 was an independent risk factor for ITBL, whereas LT for ALF, ABO‐compatible non‐identical LT, and CX3CR1‐249II allele remained predictive for AS. Serum levels of interferon‐gamma and interleukin (IL)‐6 as well as IL‐10 were significantly increased in patients with biliary strictures.ConclusionSpecific chemokine receptor polymorphisms of the recipient are associated with development of post‐LT biliary strictures. Altered cytokine profile may contribute to enhanced fibrotic tissue remodelling and biliary stricture formation. Screening of anti‐HLA antibodies might be useful for early identification of at‐risk patients who could benefit from closer surveillance and tailored immunosuppressive regimen. Our findings may have relevance for prediction and management of post‐LT biliary strictures.

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Liver International

Tập 32 Số 8

1253-1261

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