Lee Kwang-Woong, Simpkins Christopher E, Montgomery Robert A, Locke Jayme E, Segev Dorry L, Maley Warren R
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Transplantation. 2006 Dec 27;82(12):1683-8. doi: 10.1097/01.tp.0000250936.73034.98.
Liver transplantation from donation after cardiac death (DCD) donors is an increasingly common approach for expansion of the donor organ supply. However, transplantation with DCD livers results in inferior graft survival. In this study, we examined donor and recipient characteristics that are associated with poor allograft outcomes and present a set of criteria that permit allograft survival that is comparable to that of donation after brain death (DBD) grafts in both low- and high-risk recipients.
The United Network for Organ Sharing/Organ Procurement and Transplantation Network Liver Transplantation Registry between January 1996 and March 2006 was investigated. Adult DCD liver transplants (n = 874) were included.
A DCD risk index was developed using the statistically significant factors from a multivariate Cox model: history of previous transplantation, life support status at transplantation, donor age, donor warm ischemia time (DWIT), and cold ischemia time (CIT). Favorable DCD donor criteria were donor age < or =45 years, DWIT < or =15 min, and CIT < or =10 hr. Four risk groups were developed based upon index scores that showed different graft survival. Graft survival of the favorable DCD group (84.9% at 1 year, 75.2% at 3 years, and 69.4% at 5 years) was comparable to that for DBD liver transplantation irrespective of recipient condition. Increasing donor age was more highly predictive of poor outcomes in DCD compared to DBD, especially in recipients in poor preoperative condition.
DCD livers from young donors with short DWIT and CIT should be given greater consideration in order to expand the number of available donor organs.
心脏死亡后捐赠（DCD）供体的肝移植是增加供体器官供应的一种日益常见的方法。然而，使用DCD肝脏进行移植会导致移植物存活率较低。在本研究中，我们研究了与同种异体移植物不良结局相关的供体和受体特征，并提出了一组标准，该标准可使低风险和高风险受体的同种异体移植物存活率与脑死亡后捐赠（DBD）移植物相当。
调查了1996年1月至2006年3月期间的器官共享联合网络/器官获取与移植网络肝脏移植登记处。纳入成人DCD肝移植（n = 874）。
使用多变量Cox模型中的统计学显著因素制定了DCD风险指数：既往移植史、移植时的生命支持状态、供体年龄、供体热缺血时间（DWIT）和冷缺血时间（CIT）。有利的DCD供体标准为供体年龄≤45岁、DWIT≤15分钟和CIT≤10小时。根据显示不同移植物存活率的指数评分划分出四个风险组。无论受体情况如何，有利的DCD组的移植物存活率（1年时为84.9%，3年时为75.2%，5年时为69.4%）与DBD肝移植相当。与DBD相比，供体年龄增加对DCD不良结局的预测性更高，尤其是在术前状况较差的受体中。
为了增加可用供体器官的数量，应更多地考虑使用DWIT和CIT短的年轻供体的DCD肝脏。
