Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL 32224, USA.
Transpl Int. 2012 Aug;25(8):838-46. doi: 10.1111/j.1432-2277.2012.01508.x. Epub 2012 Jun 15.
This study sought to determine the procurement factors that lead to development of intrahepatic bile duct strictures (ITBS) and overall biliary complications in recipients of donation after cardiac death (DCD) liver grafts. Detailed information for different time points during procurement (withdrawal of support; SBP < 50 mmHg; oxygen saturation <30%; mandatory wait period; asystole; incision; aortic cross clamp) and their association with the development of ITBS and overall biliary complications were examined using logistic regression. Two hundred and fifteen liver transplants using DCD donors were performed between 1998 and 2010 at Mayo Clinic Florida. Of all the time periods during procurement, only asystole-cross clamp period was significantly different between patients with ITBS versus no ITBS (P = 0.048) and between the patients who had overall biliary complications versus no biliary complications (P = 0.047). On multivariate analysis, only asystole-cross clamp period was significant predictor for development of ITBS (P = 0.015) and development of overall biliary complications (P = 0.029). Hemodynamic changes in the agonal period did not emerge as risk factors. The results of the study raise the possibility of utilizing asystole-cross-clamp period in place of or in conjunction with donor warm ischemia time in determining viability or quality of liver grafts.
本研究旨在确定导致心脏死亡后供体（DCD）肝移植受者发生肝内胆管狭窄（ITBS）和总体胆道并发症的采集因素。使用逻辑回归检查了采集过程中不同时间点（支持撤出；SBP < 50mmHg；氧饱和度 < 30%；强制性等待期；心脏停搏；切口；主动脉交叉夹闭）的详细信息及其与 ITBS 和总体胆道并发症发展的关系。1998 年至 2010 年间，在佛罗里达州梅奥诊所进行了 215 例使用 DCD 供体的肝移植。在采集过程中的所有时间段中，只有心脏停搏-主动脉夹闭时间段在 ITBS 患者与无 ITBS 患者之间（P = 0.048）和有总体胆道并发症患者与无胆道并发症患者之间（P = 0.047）有显著差异。多变量分析显示，只有心脏停搏-主动脉夹闭时间段是 ITBS 发展（P = 0.015）和总体胆道并发症发展（P = 0.029）的显著预测因素。濒死期的血流动力学变化并未成为危险因素。该研究结果提出了在确定肝移植物的存活或质量时，可以使用心脏停搏-夹闭时间段替代或结合供体热缺血时间的可能性。
