Ferraz-Neto B H, Zurstrassen M P V C, Hidalgo R, Fonseca L E P, Motta T D B, Pandullo F L, Rezende M B, Meira-Filho S P, Sá J R, Afonso R C
Albert Einstein Jewish Hospital, Av. Albert Einstein 627/701, 05652-900 São Paulo/SP, Brazil.
Transplant Proc. 2007 Oct;39(8):2516-8. doi: 10.1016/j.transproceed.2007.07.034.
Livers from marginal donors are increasingly used for transplantation due to the shortage of donor organs. The definition of a marginal donor remains unclear; prediction of organ function is a challenge. In the literature the use of steatotic livers has been associated with poor liver function or even primary dysfunction of the allograft. Tekin et al created a scoring system that classifies a donor as marginal or nonmarginal, using a mathematical model based on donor age and steatosis degree. The aims of this study were to apply the Tekin method to identify marginal and nonmarginal donors and evaluate the influence of the cold ischemia time (CIT) on allograft evolution. We retrospectively reviewed deceased donor liver transplantations performed from October 1995 to March 2006, namely, 177 adult liver transplantations in 163 patients. Fifty-five were excluded due to retransplantation (14) or insufficient data (41). Donor age and macrovesicular steatosis were evaluated according to the mathematical formula proposed by Tekin et al, classifying the donors as marginal versus nonmarginal. The authors also analyzed the CIT, 3-month mortality, and development of primary nonfunction or primary dysfunction. The median donor age was 38.9 years (range, 6-71). The postreperfusion biopsy specimen showed moderate to intense steatosis (>30%) in 14.75% of specimens, with no steatosis or mild steatosis in 85.25%. Sixty-one grafts (50%) developed primary graft dysfunction (PGD): 10 grafts, with primary nonfunction (PNF); and 51 with initial poor function (IPF). Using the criteria provided by Tekin et al, we obtained 41 marginal and 81 nonmarginal allografts. The marginal group showed 61.9% PGD, compared with 59.2% of PGD by the nonmarginal group. The CIT was greater than 12 hours in 5 marginal group transplants and 4 PGD cases (80%). Of the nonmarginal allografts, the CIT was greater than 12 hours in 29.6%, with 75% PGD. The 3-month graft survival rate was 80% in the marginal group with ischemia time more than 12 hours: 86.1% of the same group when CIT was less than 12 hours, and 82.7% in the nonmarginal group. In contrast, when we analyzed the occurrence of allograft dysfunction, the 3-month mortality rate was 34% among, grafts with dysfunction, whereas, in those without initial dysfunction, it was 4.1%. In conclusion, the score suggested by Tekin et al that classifies the donors as ideal (nonmarginal) or marginal was not able to predict initial primary dysfunction.
由于供体器官短缺，边缘供体的肝脏越来越多地用于移植。边缘供体的定义仍不明确；预测器官功能是一项挑战。在文献中，使用脂肪变性肝脏与肝功能不良甚至同种异体移植物的原发性功能障碍有关。Tekin等人创建了一个评分系统，使用基于供体年龄和脂肪变性程度的数学模型将供体分类为边缘或非边缘供体。本研究的目的是应用Tekin方法识别边缘和非边缘供体，并评估冷缺血时间（CIT）对同种异体移植物演变的影响。我们回顾性分析了1995年10月至2006年3月期间进行的尸体供体肝移植，即163例患者中的177例成人肝移植。55例因再次移植（14例）或数据不足（41例）被排除。根据Tekin等人提出的数学公式评估供体年龄和大泡性脂肪变性，将供体分类为边缘与非边缘。作者还分析了CIT、3个月死亡率以及原发性无功能或原发性功能障碍的发生情况。供体年龄中位数为38.9岁（范围6 - 71岁）。再灌注后活检标本显示，14.75%的标本有中度至重度脂肪变性（>30%），85.25%无脂肪变性或轻度脂肪变性。61例移植物（50%）发生原发性移植物功能障碍（PGD）：10例移植物原发性无功能（PNF）；51例初始功能不良（IPF）。使用Tekin等人提供的标准，我们获得了41例边缘同种异体移植物和81例非边缘同种异体移植物。边缘组PGD发生率为61.9%，非边缘组为59.2%。边缘组5例移植和4例PGD病例（80%）的CIT大于12小时。在非边缘同种异体移植物中，CIT大于12小时的占29.6%，PGD发生率为75%。缺血时间超过12小时的边缘组3个月移植物存活率为80%：CIT小于12小时时该组为86.1%，非边缘组为82.7%。相比之下，当我们分析同种异体移植物功能障碍的发生情况时，有功能障碍的移植物中3个月死亡率为34%，而初始无功能障碍的移植物中为4.1%。总之，Tekin等人提出的将供体分类为理想（非边缘）或边缘的评分不能预测初始原发性功能障碍。
