Nemes B, Gelley F, Zádori G, Piros L, Perneczky J, Kóbori L, Fehérvári I, Görög D
Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.
Transplant Proc. 2010 Jul-Aug;42(6):2327-30. doi: 10.1016/j.transproceed.2010.05.018.
Availability of suitable donor organs has always limited the number of liver transplantations performed. Use of marginal donor organs is an alternative to overcome organ shortage.
To analyze the effect of various combinations of donor organ quality and recipient status on the outcome of liver transplantation.
Data from 260 whole-liver transplantations performed between January 2003 and September 2009 were analyzed retrospectively. Study groups were established according to donor organ quality (marginal score 0-1 vs 2-5) and recipient status (Model for End-Stage Liver Disease [MELD] score <17 or >17). In patients at low risk, 102 received optimal grafts (good-to-good group [G/G], and 75 received marginal grafts (bad-to-good group [B/G]. In patients at high risk, 46 received optimal grafts (good-to-bad group [G/B], and 37 received marginal grafts (bad-to-bad group [B/B].
No differences were observed in cumulative patient and graft survival rates; however, total survival differed in the early period after transplantation, that is, within 1 year. There was a higher rate of overall postoperative complications including initial poor graft function, bleeding, infection, and kidney failure in group B/B compared with group G/B (25 of 37 patients [67.5%] vs 27 of 46 patients [59.0%]), group B/G (25 of 37 patients [68%] vs 39 of 75 patients [52%], and group G/G (25 of 37 patients [68%] vs 43 of 102 patients [42%]) (P = .04). Patients with a high MELD score (G/B and B/B) demonstrated increased risk of postoperative complications. Use of donor organs with marginal score of 2 or higher in patients with high MELD scores increased early patient mortality.
In summary, patients with a high MELD score (G/B and B/B) are at an increased risk of post-OLT complications. In contrast, use of marginal grafts (B/G and B/B) increased the rate of hepatitis C virus recurrence and decreased the response rate to antiviral therapy. The combination of impaired donor grafts and recipients at high risk should be avoided.
合适供体器官的可获得性一直限制着肝移植手术的数量。使用边缘供体器官是克服器官短缺的一种替代方法。
分析供体器官质量和受体状况的各种组合对肝移植结果的影响。
回顾性分析2003年1月至2009年9月期间进行的260例全肝移植的数据。根据供体器官质量（边缘评分0 - 1与2 - 5）和受体状况（终末期肝病模型[MELD]评分<17或>17）建立研究组。在低风险患者中，102例接受了最佳移植物（优 - 优组[G/G]），75例接受了边缘移植物（差 - 优组[B/G]）。在高风险患者中，46例接受了最佳移植物（优 - 差组[G/B]），37例接受了边缘移植物（差 - 差组[B/B]）。
患者和移植物累积生存率未观察到差异；然而，移植后早期（即1年内）总生存率有所不同。与G/B组（46例患者中的27例[59.0%]）、B/G组（75例患者中的39例[52%]）和G/G组（102例患者中的43例[42%]）相比，B/B组术后总体并发症发生率更高，包括初始移植物功能不良、出血、感染和肾衰竭（37例患者中的25例[67.5%]）（P = 0.04）。MELD评分高的患者（G/B和B/B）术后并发症风险增加。在MELD评分高的患者中使用边缘评分为2或更高的供体器官会增加早期患者死亡率。
总之，MELD评分高的患者（G/B和B/B）肝移植术后并发症风险增加。相比之下，使用边缘移植物（B/G和B/B）会增加丙型肝炎病毒复发率并降低抗病毒治疗的反应率。应避免使用受损供体移植物与高风险受体的组合。
