Mateo R, Cho Y, Singh G, Stapfer M, Donovan J, Kahn J, Fong T-L, Sher L, Jabbour N, Aswad S, Selby R R, Genyk Y
Department of Surgery, Division of Transplantation, Keck--USC School of Medicine, Los Angeles, California, USA.
Am J Transplant. 2006 Apr;6(4):791-6. doi: 10.1111/j.1600-6143.2006.01243.x.
Due to increasing use of allografts from donation after cardiac death (DCD) donors, we evaluated DCD liver transplants and impact of recipient and donor factors on graft survival. Liver transplants from DCD donors reported to UNOS were analyzed against donation after brain death (DBD) donor liver transplants performed between 1996 and 2003. We defined a recipient cumulative relative risk (RCRR) using significant risk factors identified from a Cox regression analysis: age; medical condition at transplantation; regraft status; dialysis received and serum creatinine. Graft survival from DCD donors (71% at 1 year and 60% at 3 years) were significantly inferior to DBD donors (80% at 1 year and 72% at 3 years, p < 0.001). Low-risk recipients (RCRR < or = 1.5) with low-risk DCD livers (DWIT < 30 min and CIT < 10 h, n = 226) achieved graft survival rates (81% and 67% at 1 and 3 years, respectively) not significantly different from recipients with DBD allografts (80% and 72% at 1 and 3 years, respectively, log-rank p = 0.23). Liver allografts from DCD donors may be used to increase the cadaveric donor pool, with favorable graft survival rates achieved when low-risk grafts are transplanted in a low-risk setting. Whether transplantation of these organs in low-risk recipients provides a survival benefit compared to the waiting list is unknown.
由于来自心脏死亡后捐赠（DCD）供体的同种异体移植物使用增加，我们评估了DCD肝移植以及受者和供体因素对移植物存活的影响。将向器官共享联合网络（UNOS）报告的DCD供体肝移植与1996年至2003年期间进行的脑死亡后捐赠（DBD）供体肝移植进行分析。我们使用从Cox回归分析中确定的显著风险因素定义了受者累积相对风险（RCRR）：年龄；移植时的医疗状况；再次移植状态；接受的透析和血清肌酐。DCD供体的移植物存活率（1年时为71%，3年时为60%）显著低于DBD供体（1年时为80%，3年时为72%，p<0.001）。具有低风险DCD肝脏（冷缺血时间<30分钟且热缺血时间<10小时，n=226）的低风险受者（RCRR≤1.5）实现的移植物存活率（1年和3年时分别为81%和67%）与接受DBD同种异体移植物的受者（1年和3年时分别为80%和72%，对数秩检验p=0.23）无显著差异。DCD供体的肝同种异体移植物可用于增加尸体供体库，在低风险环境中移植低风险移植物时可实现良好的移植物存活率。与等待名单相比，在低风险受者中移植这些器官是否能提供生存益处尚不清楚。
