Liver Surgery and Transplantation Unit, Institut de Malalties Digestives i Metabòliques, IDIBAPS, Hospital Clínic i Provincial, CIBERehd, University of Barcelona, Villarroel, 170, 08036, Barcelona, Spain.
World J Surg. 2012 Dec;36(12):2914-22. doi: 10.1007/s00268-012-1757-z.
Few studies have studied the effects of graft quality on non-urgent liver retransplantation (ReLT) outcomes. We aimed to analyze graft characteristics and survival in non-urgent ReLT and the effect of using grafts with extended criteria on survival.
Eighty non-urgent ReLT were performed from June 1988 to June 2010. The whole series was divided by identical time periods to study time-related effects. We assessed graft quality with donor risk index (DRI) and Briceño scores and recipient status with the Model for End-stage Liver Diseases and Rosen scores. Low and high-risk grafts were defined by a DRI cutoff of 1.8.
Graft survival was similar in both periods (1-, 5-, and 10-year graft survivals: 73.5, 46.9, and 40.8 versus 71, 47.7, and 47.7%, p=0.935) although donor quality was worse in the second period (DRI: 1.35±0.32 vs. 1.66±0.34, p<0.001). In the first period high-risk grafts did worse than low-risk grafts (5-year survival: 0 vs. 54.5%, p=0.002) while in the second period outcomes were similar (5-year survival: 48.6 vs. 56.7%, p=0.660). Donor age was the only independent donor factor for graft survival, with lower survival when using grafts from donors over 60-years-old.
Graft quality in ReLT has worsened with time mainly because of older donors but nowadays the use of high-risk grafts in non-urgent ReLT is not associated with worse graft survival because of better perioperative management. Moreover of being selective on recipient conditions, care should be taken when using grafts from donors over 60-years-old for non-urgent ReLT.
很少有研究探讨供肝质量对非紧急肝再移植（ReLT）结局的影响。本研究旨在分析非紧急 ReLT 中的供肝特征和存活率，以及使用扩展标准供肝对存活率的影响。
1988 年 6 月至 2010 年 6 月期间，进行了 80 例非紧急 ReLT。将整个系列按相同时间段分为两部分，以研究时间相关的影响。我们使用供体风险指数（DRI）和 Briceño 评分评估供肝质量，使用终末期肝病模型（MELD）和 Rosen 评分评估受体状态。低危和高危供肝的定义为 DRI 截断值为 1.8。
尽管在第二个时间段供体质量较差（DRI：1.35±0.32 对 1.66±0.34，p<0.001），但两个时间段的移植物存活率相似（1、5 和 10 年移植物存活率：73.5、46.9 和 40.8 对 71、47.7 和 47.7%，p=0.935）。在第一个时间段，高危供肝的存活率低于低危供肝（5 年存活率：0 对 54.5%，p=0.002），而在第二个时间段，结果相似（5 年存活率：48.6 对 56.7%，p=0.660）。供体年龄是影响移植物存活率的唯一独立供体因素，使用 60 岁以上供体的移植物存活率较低。
随着时间的推移，ReLT 中的供肝质量有所恶化，主要是由于老年供体增多，但如今，在非紧急 ReLT 中使用高危供肝并不与移植物存活率降低相关，这得益于更好的围手术期管理。此外，在选择受体条件时，对于非紧急 ReLT，应谨慎使用 60 岁以上供体的移植物。
