Iron metabolism imbalance at the time of listing increases overall and infectious mortality after liver transplantation

Autor: Karim Boudjema, Caroline Jezequel, Amandine Landrieux, Christophe Camus, Thomas Uguen, Dominique Guyader, Michel Rayar, Edouard Bardou-Jacquet, Pauline Houssel-Debry, Elodie Fallet, Martine Ropert-Bouchet, L. Legros
Přispěvatelé: CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
Cirrhosis
Overload
medicine.medical_treatment
[SDV]Life Sciences [q-bio]
Transferrin saturation
Liver transplantation
Gastroenterology
0302 clinical medicine
Postoperative Complications
Risk Factors
Prospective Studies
Prospective cohort study
biology
Liver Neoplasms
Transferrin
General Medicine
Iron deficiency
Middle Aged
3. Good health
Survival Rate
Death
030220 oncology & carcinogenesis
030211 gastroenterology & hepatology
Female
Infection
medicine.medical_specialty
Carcinoma
Hepatocellular
Iron
Infections
Risk Assessment
End Stage Liver Disease
03 medical and health sciences
Retrospective Study
Internal medicine
medicine
Humans
Risk factor
Retrospective Studies
Ferritin
Proportional hazards model
business.industry
medicine.disease
Liver Transplantation
Ferritins
biology.protein
Neoplasm Recurrence
Local
business
Follow-Up Studies
Zdroj: World Journal of Gastroenterology
World Journal of Gastroenterology, Baishideng Publishing Group Co. Limited, 2020, 26 (16), pp.1938-1949. ⟨10.3748/wjg.v26.i16.1938⟩
ISSN: 1007-9327
Popis: International audience; BACKGROUND Liver transplantation (LT) is the best treatment for patients with liver cancer or end stage cirrhosis, but it is still associated with a significant mortality. Therefore identifying factors associated with mortality could help improve patient management. The impact of iron metabolism, which could be a relevant therapeutic target, yield discrepant results in this setting. Previous studies suggest that increased serum ferritin is associated with higher mortality. Surprisingly iron deficiency which is a well described risk factor in critically ill patients has not been considered. AIM To assess the impact of pre-transplant iron metabolism parameters on post-transplant survival. METHODS From 2001 to 2011, 553 patients who underwent LT with iron metabolism parameters available at LT evaluation were included. Data were prospectively recorded at the time of evaluation and at the time of LT regarding donor and recipient. Serum ferritin (SF) and transferrin saturation (TS) were studied as continuous and categorical variable. Cox regression analysis was used to determine mortality risks factors. Follow-up data were obtained from the local and national database regarding causes of death. RESULTS At the end of a 95-mo median follow-up, 196 patients were dead, 38 of them because of infections. In multivariate analysis, overall mortality was significantly associated with TS > 75% [HR 1.73 (1.14; 2.63)], SF < 100 mu g/L [HR 1.62 (1.12; 2.35)], hepatocellular carcinoma [HR 1.58 (1.15; 2.26)], estimated glomerular filtration rate (CKD EPI Cystatin C) [HR 0.99 (0.98; 0.99)], and packed red blood cell transfusion [HR 1.05 (1.03; 1.08)]. Kaplan Meier curves show that patients with low SF (< 100 mu g/L) or high SF (> 400 mu g/L) have lower survival rates at 36 mo than patients with normal SF (P = 0.008 and P = 0.016 respectively). Patients with TS higher than 75% had higher mortality at 12 mo (91.4% +/- 1.4% vs 84.6% +/- 3.1%, P = 0.039). TS > 75% was significantly associated with infection related death [HR 3.06 (1.13; 8.23)]. CONCLUSION Our results show that iron metabolism imbalance (either deficiency or overload) is associated with post-transplant overall and infectious mortality. Impact of iron supplementation or depletion should be assessed in prospective study.
Databáze: OpenAIRE
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