King's College Hospital, Division of Liver Transplantation and HPB Surgery Institute for Liver Diseases, London, UK.
Ann Surg. 2011 Nov;254(5):716-22; discussion 722-3. doi: 10.1097/SLA.0b013e318235c572.
To assess the incidence and impact of biliary complications in recipients transplanted from donors after cardiac death (DCD) at one single large institution.
Shortage of available cadaveric organs is a significant limiting factor in liver transplantation (LT). The use of DCD offers the potential to increase the organ pool. However, early results with DCD liver grafts were associated with a greater incidence of ischemic cholangiopathy (IC), leading to several programs to abandoning this source of organs.
A retrospective analysis of a prospective database from April 2001 to 2010 focused on 167 consecutive DCD-LT. Each DCD transplant was matched with 2 brain death donors (DBD) grafts (n = 333) according to the period of transplantation. Primary outcome measures were biliary complications including the severity of complications, graft survival and patient survival. Minimum follow-up was 3 months.
Anastomotic stricture was the most common biliary complication (DCD = 30, 19% vs. DBD = 41, 13%). Most were treated endocoscopically (grade IIIa = 72%), whereas hepatico-jejunostomy (grade IIIb) was performed in 22%. Primary IC occurred in 4 (2.5%) recipients from the DCD group and was absent in the DBD group (P = 0.005). However, none of these patients required retransplantation. Patient and graft survival at 1, 3, and 5 years were similar between DCD and DBD groups (P = 0.106, P = 0.138, P = 0.113, respectively).
The encouraging results with DCD-LT are probably due to the selection of DCD grafts and clear definition of warm ischemia.
评估在一个单一的大型机构中，从心脏死亡供体（DCD）接受者中移植的胆道并发症的发生率和影响。
可供使用的尸体器官短缺是肝移植（LT）的一个重大限制因素。使用 DCD 提供了增加器官库的潜力。然而，DCD 肝移植物的早期结果与缺血性胆管病（IC）的发生率较高有关，导致一些项目放弃了这种器官来源。
对 2001 年 4 月至 2010 年的前瞻性数据库进行回顾性分析，重点是 167 例连续的 DCD-LT。根据移植时间，每个 DCD 移植都与 2 例脑死亡供体（DBD）移植物匹配（n = 333）。主要观察指标是胆道并发症，包括并发症的严重程度、移植物存活率和患者存活率。最小随访时间为 3 个月。
吻合口狭窄是最常见的胆道并发症（DCD = 30，19% vs. DBD = 41，13%）。大多数通过内镜治疗（IIIa 级 = 72%），而肝肠吻合术（IIIb 级）则进行了 22%。DCD 组中有 4 例（2.5%）患者发生原发性 IC，而 DBD 组则无（P = 0.005）。然而，这些患者均无需再次移植。DCD 和 DBD 组患者和移植物的 1、3 和 5 年存活率相似（P = 0.106、P = 0.138、P = 0.113）。
DCD-LT 的令人鼓舞的结果可能归因于 DCD 移植物的选择和明确的热缺血定义。
