Abstract
Liver transplantation has become the ultimate treatment for patients with end stage liver disease. However, early allograft dysfunction (EAD) has been associated with allograft loss or mortality after transplantation. We aim to utilize a metabolomic platform to identify novel biomarkers for more accurate correlation with EAD using blood samples collected from 51 recipients undergoing living donor liver transplantation (LDLT) by 1H-nuclear magnetic resonance spectroscopy (NMR) and liquid chromatography coupled with mass spectrometry (LC-MS). Principal component analysis (PCA) and orthogonal projection to latent structures-discriminant analysis (OPLS-DA) were used to search for a relationship between the metabolomic profiles and the presence of EAD.Cholesteryl esters (CEs), triacylglycerols (TGs), phosphatidylcholines (PCs) and lysophosphatidylcholine (lysoPC) were identified in association with EAD and a combination of cholesterol oleate, PC (16:0/16:0), and lysoPC (16:0) gave an optimal area under the curve (AUC) of 0.9487 and 0.7884 in the prediction of EAD and in-hospital mortality, respectively after LDLT. Such biomarkers may add as a potential clinical panel for the prediction of graft function and mortality after LDLT.
Highlights
Over the past few decades, liver transplantation has been a lifesaving treatment for individuals with end stage liver disease and acute liver failure [1]
Flow diagram ofcarcinoma; the patientEAD, selection, and analysis.nuclear magnetic resonance spectroscopy (NMR), hepatocellular carcinoma (HCC),nuclear hepatocellular magnetic resonance spectroscopy; LC-MS, liquid chromatography coupled with mass spectrometry
The Biological Model for End-Stage Liver Disease (MELD) score was calculated on the day of transplantation in all cases
Summary
Over the past few decades, liver transplantation has been a lifesaving treatment for individuals with end stage liver disease and acute liver failure [1]. Because of the scarcity of available organs, extended criteria donors (ECD) are routinely used around the world for recipients who urgently require liver transplantation. Med. 2019, 8, 30 transplantation (LDLT) has become widely accepted, achieving an impressive 1-year graft and recipient survival rate of nearly 90%, similar to that of deceased donor liver transplantation [2,3]. A recent cohort study has reported an incidence of EAD of approximately 25% after LDLT, and the risk of graft failure at 90 days was 5.2 times higher in recipients with EAD than for those without. Preoperative bilirubin, portal reperfusion pressure, donor age and donor body mass index have been identified as risk factors associated with EAD [5,6]. No unanimous definitions have been used to characterize EAD, for this study we adopted the most commonly used and recently validated version [7,8], in which the diagnosis of EAD was clinically based on the levels of serum transaminases, total bilirubin and the international normalized ratio within the first postoperative week
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