吲哚菁绿实验与二维剪切波弹性成像技术对肝移植术后早期移植物功能障碍发生的评估价值

The Value of Indocyanine Green Clearance Test and Two-Dimensional Shear Wave Elastography in Assessing the Risk of Early Allograft Dysfunction after Liver Transplantation

摘要: 目的：探讨吲哚菁绿实验与二维剪切波弹性成像技术对肝移植术后早期移植物功能障碍(EAD)发生的评估价值。方法：选择2024年4月至2025年6月在安徽医科大学第二附属医院器官移植中心接受肝移植手术的患者，供肝获取前均在本院ICU完善ICG及2D SWE检查。回顾性分析纳入的33例供受者资料，根据受体术后早期的肝功能恢复情况进行分组，其中10例发生EAD作为观察组，23例术后肝功能正常组作为对照组。对两组指标进行比较，有差异的指标进行logistic回归分析，并绘制受试者工作特征曲线(ROC)，计算曲线下面积(AUC)，分析相关因素的判断效能。结果：EAD组受者供肝的杨氏模量值(Emean)、术前MELD评分显著高于对照组，吲哚菁绿滞留实验(ICG R15)无差异。Logistic回归分析结果显示供体肝脏Emean > 4.33 Kpa及受体术前MELD评分 > 23是受者肝移植术后发生EAD的危险因素；ROC曲线显示，供肝Emean预测受体术后EAD发生的AUC为 0.770 (95% CI: 0.574~0.965, P < 0.05)，受体MELD评分预测受体术后EAD发生的AUC为 0.828 (95% CI: 0.663~0.994, P < 0.05)，Emean联合MELD预测受体术后EAD发生的AUC为 0.917 (95% CI: 0.812~1.000, P < 0.05)。结论：初步结论表明供肝的二维剪切波弹性成像杨氏模量值(Emean)升高及受者术前MELD评分升高与肝移植术后早期移植物功能障碍的发生风险增加相关。本研究提示，术前无创测量供肝Emean可能有助于识别术后发生EAD风险较高的供肝，尤其是当联合受体MELD评分进行综合评估时。这些发现为无创评估供肝质量提供了初步依据，但其临床应用的预测效能仍需在更大样本的前瞻性研究中进一步验证。

Abstract: Objective: Evaluation of the predictive value of indocyanine green clearance test and two-dimensional shear wave elastography for early allograft dysfunction (EAD) after liver transplantation. Methods: This study retrospectively analyzed data from 33 donor-recipient pairs who underwent liver transplantation at the Organ Transplantation Center of the Second Affiliated Hospital of Anhui Medical University between April 2022 and June 2025. Prior to donor liver procurement, all donors completed ICG testing and 2D-SWE examination in the ICU. Patients were divided into two groups based on early postoperative liver function recovery: the observation group (n = 10) with EAD and the control group (n = 23) with normal liver function. Parameters showing significant differences between groups were subjected to logistic regression analysis. Receiver operating characteristic (ROC) curves were plotted to calculate the area under the curve (AUC) and evaluate the predictive efficacy of relevant factors. Results: The EAD group exhibited significantly higher Young’s modulus values (Emean) of donor livers and preoperative MELD scores compared to the control group, while no significant difference was observed in indocyanine green retention rate at 15 minutes (ICG R15). Logistic regression analysis revealed that a donor liver Emean > 4.33 kPa and recipient preoperative MELD score > 23 were independent risk factors for postoperative EAD. ROC curve analysis demonstrated that the AUC for donor liver Emean in predicting EAD was 0.770 (95% CI: 0.574~0.965, P < 0.05), for MELD score was 0.828 (95% CI: 0.663~0.994, P < 0.05), and for the combined Emean and MELD score was 0.917 (95% CI: 0.812~1.000, P < 0.05). Conclusion: Preliminary findings indicate that elevated Young's modulus values (Emean) measured by two-dimensional shear wave elastography (2D-SWE) in donor livers, along with higher preoperative Model for End-Stage Liver Disease (MELD) scores in recipients, are associated with an increased risk of early allograft dysfunction (EAD) following liver transplantation. This study suggests that preoperative noninvasive measurement of donor liver Emean may help identify grafts at higher risk for developing EAD postoperatively, particularly when combined with recipient MELD score for comprehensive assessment. These findings provide preliminary evidence supporting the noninvasive assessment of donor liver quality. However, the predictive performance of this approach for clinical application requires further validation in larger prospective studies.