单中心心脏死亡后供肝肝移植的长期预后

Long-term outcomes of donation after cardiac death liver allografts from a single center.

作者信息

Nguyen Justin H, Bonatti Hugo, Dickson Rolland C, Hewitt Winston R, Grewal Hani P, Willingham Darrin L, Harnois Denise M, Schmitt Timothy M, Machicao Victor I, Ghabril Marwan S, Keaveny Andrew P, Aranda-Michel Jaime, Satyanarayana Raj, Rosser Barry G, Hinder Ronald A, Steers Jeffery L, Hughes Christopher B

机构信息

Divisions of Transplant Surgery and Transplant Hepatology, Department of Transplantation, Mayo Clinic College of Medicine, Jacksonville, FL 32224, USA.

出版信息

Clin Transplant. 2009 Mar-Apr;23(2):168-73. doi: 10.1111/j.1399-0012.2009.00968.x. Epub 2009 Feb 11.

DOI:10.1111/j.1399-0012.2009.00968.x

PMID:19220366

Abstract

Organ shortage continues to be a major challenge in transplantation. Recent experience with controlled non-heart-beating or donation after cardiac death (DCD) are encouraging. However, long-term outcomes of DCD liver allografts are limited. In this study, we present outcomes of 19 DCD liver allografts with follow-up >4.5 years. During 1998-2001, 19 (4.1%) liver transplants (LT) with DCD allografts were performed at our center. Conventional heart-beating donors included 234 standard criteria donors (SCD) and 214 extended criteria donors (ECD). We found that DCD allografts had equivalent rates of primary non-function and biliary complications as compared with SCD and ECD. The overall one-, two-, and five-yr DCD graft and patient survival was 73.7%, 68.4%, and 63.2%, and 89.5%, 89.5%, and 89.5%, respectively. DCD graft survival was similar to graft survival of SCD and ECD in non hepatitis C virus (HCV) recipients (p > 0.370). In contrast, DCD graft survival was significantly reduced in HCV recipients (p = 0.007). In conclusion, DCD liver allografts are durable and have acceptable long-term outcomes. Further research is required to assess the impact of HCV on DCD allograft survival.

摘要

器官短缺仍然是移植领域的一项重大挑战。近期关于控制性非心脏跳动供体或心脏死亡后捐赠（DCD）的经验令人鼓舞。然而，DCD肝移植的长期结果有限。在本研究中，我们报告了19例DCD肝移植的结果，随访时间超过4.5年。1998年至2001年期间，我们中心进行了19例（4.1%）DCD肝移植。传统心脏跳动供体包括234例标准标准供体（SCD）和214例扩展标准供体（ECD）。我们发现，与SCD和ECD相比，DCD肝移植的原发性无功能和胆道并发症发生率相当。DCD肝移植和患者的总体1年、2年和5年生存率分别为73.7%、68.4%和63.2%，以及89.5%、89.5%和89.5%。在非丙型肝炎病毒（HCV）受体中，DCD肝移植的生存率与SCD和ECD的肝移植生存率相似（p>0.370）。相比之下，HCV受体中DCD肝移植的生存率显著降低（p=0.007）。总之，DCD肝移植具有耐久性，长期结果可接受。需要进一步研究以评估HCV对DCD肝移植生存率的影响。