Impact of the serum ferritin concentration in liver transplantation

Abstract

The serum ferritin (SF) concentration is a widely available and objective laboratory parameter. SF is also widely recognized as an acute-phase reactant. The purpose of the present study was to identify the chronological changes in the recipient's SF concentration during liver transplantation (LT) and to clarify factors having an effect on the recipient's intraoperative SF level. In addition, the study retrospectively evaluated the usefulness of measuring SF during LT. Ninety-eight pediatric recipients were retrospectively analyzed. The data were analyzed and compared according to the SF level in the recipient. Patients were classified into 2 groups based on the intraoperative peak SF levels of ≤ 1000 ng/mL (low-SF group) or >1000 ng/mL (high-SF group). The SF value increased dramatically after reperfusion and fell to normal levels within the early postoperative period. The warm ischemia time (WIT) was significantly longer in the high-SF group (47.0 versus 58.5 minutes; P = 0.003). In addition, a significant positive correlation was observed between the peak SF value and WIT (r = 0.35; P < 0.001). There were significant positive correlations between the peak SF value and the donors' preoperative laboratory data, including transaminases, cholinesterase, hemoglobin, transferrin saturation, and SF, of which SF showed the strongest positive correlation (r = 0.74; P < 0.001). The multivariate analysis revealed that WIT and donor's SF level were a significant risk factor for high SF level in the recipient (P = 0.007 and 0.02, respectively). In conclusion, the SF measurement can suggest the degree of ischemia/reperfusion injury (IRI). A high SF level in the donor is associated with the risk of further acute reactions, such as IRI, in the recipient.

Iron overload as a risk factor for hepatic ischemia-reperfusion injury in liver transplantation: Potential role of ferroptosis

“…There was no significant difference in preoperative SF levels between the recipients and donors (Figure S1A). As we reported previously, there was a strong positive correlation between the preoperative SF level of the donor and ΔSF (Figure S1B) . Moreover, a positive correlation was detected between ΔSF and ΔAST or ΔALT (Figure S1C).…”

Correlation between HDL2, HDL3 and serum ferritin levels with fatty liver and NAFLD activity score (NAS) in liver histology of organ donors

“…In addition, in this study, serum ferritin > 1000 ng/ml in transplant recipients was associated with longer warm ischemia time and increased levels of hepatic transaminases after surgery. Finally, in this study, increased ferritin levels in organ donors were introduced as a predictor of ischemia/reperfusion injury in donated liver [ 20 ]. These findings are similar to the results of our study that elevated Ferritin levels in donors were associated with increased hepatic transaminases in recipients.…”

Association of iron overload with infectious complications in liver transplant recipients: a systematic review and meta-analysis

“…A previous study showed that the serum ferritin level can indicate the degree of ischemia/reperfusion injury in LT. 30 We performed a subgroup analysis using a fixed-effects model to determine whether the serum ferritin level can be evaluated as a noninvasive prognostic indicator on its own. Three studies assessed the serum ferritin level during the evaluation of patients undergoing LT. 22,25,26 In another study, the serum ferritin level was examined within 72 hours after LT. 20…”

“…A previous study showed that the serum ferritin level can indicate the degree of ischemia/reperfusion injury in LT. 30 We performed a subgroup analysis using a fixed-effects model to determine whether the serum ferritin level can be evaluated as a noninvasive prognostic indicator on its own. Three studies assessed the serum ferritin level during the evaluation of patients undergoing LT. 22,25,26 In another study, the serum ferritin level was examined within 72 hours after LT. 20 The pooled results revealed that a high preoperative or postoperative serum ferritin level was significantly associated with an increased risk of death (HR, 1.34; 95% CI, 1.10-1.64; p ¼ 0.004), and heterogeneity was low (I 2 ¼ 46%) (Figure 3(b)).…”