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目的:研究供肝胆管反应在肝移植疗效评价中的作用。方法:回顾性收集2015年1月至2020年12月100例在树兰（杭州）医院接受肝移植手术受者及其相应供者临床资料，根据是否接受脂肪变性供肝将其分为肝脂肪变性组（HS组，65例）和非脂肪变性组（non-HS组，35例），根据是否发生早期移植物功能不全（early allograft dysfunction，EAD）分为（EAD组，33例）和非EAD组（non-EAD组，67例）。用免疫组织化学染色标本中细胞角蛋白19（cytokeratin 19，CK19）阳性胆管细胞所占染色面积百分比定义胆管反应程度（用DR值表示）。分析比较HS组和non-HS组、EAD组和non-EAD组供肝的DR值，利用单因素及多因素Logistic回归分析，确定EAD的危险因素；根据受者接受的供肝胆管反应程度（DR=0.4为临界值）结合其是否为脂肪变性供肝进行亚组分析，评价脂肪变性供肝中胆管反应程度对肝移植术后EAD发生率和生存的影响。结果:HS组（65例）供肝DR（0.59%±0.385%）高于非脂肪变性供肝（0.32%±0.194%）（ P<0.01），EAD组供肝DR（0.72%±0.449%）高于非EAD组供肝（0.38%±0.226%）（ P<0.01）。多因素Logistic回归分析提示供肝高胆管反应是移植术后发生EAD的独立危险因素。亚组分析结果提示，接受脂肪变性且低胆管反应程度（DR<0.4%）供肝与接受非脂肪变性供肝移植后受者EAD的发生及生存相当。 结论:低胆管反应程度的脂肪变性供肝可安全用于肝移植，结合供肝胆管反应程度的移植肝损伤评价新体系可有效拓展脂肪变性供肝的临床应用。

Objective:To explore the role of ductular reaction in assessing the efficacy of liver transplantation.Method:From January 2015 to December 2020, he relevant clinical data were retrospectively reviewed for 100 recipients and their corresponding donors at Shulan (Hangzhou) Hospital. They were assigned into two groups of hepatic steatosis (HS group, 65 cases) and non-hepatic steatosis (non-HS group, 35 cases) according to whether or not receiving steatosis donated liver. Furthermore, based upon the occurrence of early allograft dysfunction (EAD), the participants were categorized into two groups of EAD (33 cases) and non-EAD (67 cases). The degree of bile duct reaction ductular reaction was defined by the percentage of staining area occupied by cytokeratin 19 (CK19) -positive bile duct cells in immunohistochemical-stained specimens. Donor of ductular reaction were compared between HS/non-HS and EAD/non-EAD groups. The risk factors for EAD were identified by univariate and multivariate Logistic regression analysis. Subgroup analysis was conducted based upon the level of ductular reaction (DR number) in donors (DR=0.4 as a threshold) and whether or not donors exhibited steatosis. The impact of DR was examined on the incidence of EAD and survival post-liver transplantation in steatosis donors.Result:The level of DR was higher in steatosis donor than that in non-steatosis donor [ (0.59%±0.385%) vs. (0.32%±0.194%), P<0.01]. And it was higher in EAD group than that in non-EAD group [ (0.72%±0.449%) vs. (0.38%±0.226%), P<0.01]. Multivariate logistic regression analysis showed that a high level of ductular reaction was an independent risk factor for EAD post-liver transplantation in donor. Subgroup analysis revealed that receiving a steatosis donor with low ductular reaction (DR<0.4%) had comparable levels of EAD occurrence and overall survival rate to receiving a non-steatosis donor. Conclusion:Steatosis with low ductular reaction donor may be safely applied for liver transplantation. And assessing donor injury based upon ductular reaction can effectively expand the clinical application of steatosis donors.