Relationship Between Liver Quality and Acute Rejection and Early Liver Function Recovery After Liver Transplantation

SUN Yibo; ZHAO Yunfeng; MIAO Shuzhai

doi:10.3969/j.issn.2096-305X.2025.06.012

Abstract：Objective To investigate the correlation between donor liver quality and the incidence of acute rejection as well as early postoperative liver function recovery in liver transplant recipients.Methods A retrospective analysis was conducted on the clinical data of 93 patients with decompensated liver cirrhosis who underwent liver transplantation at Zhengzhou People's Hospital from March 2022 to March 2025.The baseline data,surgical parameters,postoperative liver function indicators,and donor liver quality indicators of the patients were collected.The patients were divided into the rejection group(21 cases)and the non-rejection group(72 cases)based on whether acute rejection occurred within 14 days after surgery.The differences in donor and recipient-related indicators between the two groups were compared.Univariate and multivariate Cox regression analyses were used to screen independent influencing factors,and correlation analysis was conducted.Results The levels of alanine aminotransferase(ALT),alkaline phosphatase(ALP),gamma-glutamyl transferase(GGT),and total bilirubin(TB)on the third postoperative day,as well as the operation time,were all higher in the rejection group than in the non-rejection group.Meanwhile,the albumin(ALB)level on the third postoperative day in the rejection group was significantly lower than that in the non-rejection group(P＜0.05);compared with the non-rejection group,the total ischemic time,cold ischemic time,graft-to-recipient weight ratio(GRWR),and the proportion of patients with fatty liver and hepatocyte edema were significantly higher in the rejection group(P＜0.05);multivariate analysis of multiple logistic regression showed that ALB on the third day after surgery was a protective factor,while ALT on the third day after surgery,operation time,cold ischemia time of donor liver,and donor liver cell edema were risk factors for acute rejection in patients(P＜0.05);the Pearson correlation analysis indicated that on the third day after surgery,ALB was significantly negatively correlated with the operation time,the cold ischemia time of the donor liver,the degree of cell edema of the donor liver,and GRWR;while ALT was significantly positively correlated with these indicators.The operation time was positively correlated with the cold ischemia time,cell edema,and GRWR,and the cell edema of the donor liver was also positively correlated with the cold ischemia time.Conclusion The quality of the donor liver has a significant impact on acute rejection reactions after liver transplantation and the early recovery of liver function.Optimizing the assessment of the donor liver,controlling the cold ischemia time,reducing liver histological damage,shortening the operation time,and closely monitoring liver function early on can help reduce the risk of acute rejection,improve the success rate of transplantation,and enhance the prognosis of patients.