Department of Abdominal Surgery and Transplantation, University Hospital of Liège, University of Liège, 4000 Liège, Belgium.
World J Gastroenterol. 2012 Sep 7;18(33):4491-506. doi: 10.3748/wjg.v18.i33.4491.
The renewed interest in donation after cardio-circulatory death (DCD) started in the 1990s following the limited success of the transplant community to expand the donation after brain-death (DBD) organ supply and following the request of potential DCD families. Since then, DCD organ procurement and transplantation activities have rapidly expanded, particularly for non-vital organs, like kidneys. In liver transplantation (LT), DCD donors are a valuable organ source that helps to decrease the mortality rate on the waiting lists and to increase the availability of organs for transplantation despite a higher risk of early graft dysfunction, more frequent vascular and ischemia-type biliary lesions, higher rates of re-listing and re-transplantation and lower graft survival, which are obviously due to the inevitable warm ischemia occurring during the declaration of death and organ retrieval process. Experimental strategies intervening in both donors and recipients at different phases of the transplantation process have focused on the attenuation of ischemia-reperfusion injury and already gained encouraging results, and some of them have found their way from pre-clinical success into clinical reality. The future of DCD-LT is promising. Concerted efforts should concentrate on the identification of suitable donors (probably Maastricht category III DCD donors), better donor and recipient matching (high risk donors to low risk recipients), use of advanced organ preservation techniques (oxygenated hypothermic machine perfusion, normothermic machine perfusion, venous systemic oxygen persufflation), and pharmacological modulation (probably a multi-factorial biologic modulation strategy) so that DCD liver allografts could be safely utilized and attain equivalent results as DBD-LT.
在脑死亡（DBD）器官供体供应扩大的有限成功以及潜在 DCD 家庭的要求之后，人们对心搏骤停后捐献（DCD）的兴趣在 20 世纪 90 年代重新燃起。从那时起，DCD 器官采集和移植活动迅速扩大，特别是对于非重要器官，如肾脏。在肝移植（LT）中，DCD 供体是一种有价值的器官来源，可以帮助降低等待名单上的死亡率，并增加可用于移植的器官数量，尽管早期移植物功能障碍的风险较高、血管和缺血性胆管损伤更频繁、重新列出和再次移植的比率更高，以及移植物存活率较低，这些显然是由于在宣布死亡和器官采集过程中不可避免的热缺血。在移植过程的不同阶段干预供体和受体的实验策略侧重于减轻缺血再灌注损伤，并且已经取得了令人鼓舞的结果，其中一些已经从临床前成功进入临床现实。DCD-LT 的未来是有希望的。应该集中精力寻找合适的供体（可能是马斯特里赫特 III 类 DCD 供体），更好地进行供体和受体匹配（高危供体与低危受体匹配），使用先进的器官保存技术（充氧低温机器灌注、常温机器灌注、静脉全身氧灌注），以及药物调节（可能是多因素生物调节策略），以便安全地利用 DCD 肝移植物并达到与 DBD-LT 相当的结果。
