Division of Transplant Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee.
Department of Surgery, Dumont-UCLA Liver Cancer and Transplant Centers, Pfleger Liver Institute, University of California, Los Angeles3Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles.
JAMA Surg. 2014 Jan;149(1):77-82. doi: 10.1001/jamasurg.2013.3195.
While orthotopic liver transplantation (OLT) is a durable life-saving treatment for patients with irreversible liver disease, the waiting list mortality rate for children younger than 6 years is 4 times higher than for children aged 11 to 17 years and adults owing to scarce availability of size-appropriate grafts for transplantation.
To compare long-term outcomes for children (aged ≤18 years) undergoing OLT using grafts from donation after circulatory death (DCD) and donation after brain death (DBD).
DESIGN, SETTING, AND PARTICIPANTS: Retrospective study using case-control matched groups at a university transplant center. All patients aged 18 years and younger who underwent OLT using DCD organs between February 1, 1990, and November 30, 2010, at the University of California, Los Angeles, were matched in a 1 to 3 ratio with patients who received primary OLT from DBD donors within a 12-month period. Other matching criteria included recipient age, weight, cause of liver disease, and acuity of illness. Outcomes after OLT were compared for DCD (n = 7) and DBD (n = 21) donors. The median follow-up was 4.5 years.
The primary outcome measure was graft failure-free survival; the secondary end point was the development of ischemic cholangiopathy.
Comparing DCD and DBD groups, recipient median age (28.4 vs 20.1 months, respectively; P = .80), weight (12.0 vs 11.6 kg, respectively; P = .87), Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease score (19 vs 11, respectively; P = .48), and donor age (24.0 vs 13.1 months, respectively; P = .72) were similar. For the DCD donors, the median donor warm ischemia duration was 24 minutes. Liver test results were similar for both groups at 1 week and 3, 6, and 12 months following OLT. Ten-year patient and graft survival rates for both DCD and DBD were 100%. Neither ischemic cholangiopathy nor vascular complications occurred in the DCD group. Biliary anastomotic strictures occurred in 1 DCD patient and 3 DBD patients.
Our study showed excellent long-term outcomes with liver transplantation in children using DCD organs. Use of liver grafts procured after circulatory death is an effective approach to expand the donor pool and remains an untapped resource for children with end-stage liver disease.
虽然原位肝移植（OLT）是治疗不可逆肝病患者的一种持久的救命治疗方法，但由于适合移植的大小合适的移植物稀缺，6 岁以下儿童的候补名单死亡率是 11 至 17 岁儿童和成人的 4 倍。
比较使用来自心脏死亡后捐献（DCD）和脑死亡后捐献（DBD）的供体进行 OLT 的儿童（≤18 岁）的长期结果。
设计、地点和参与者：在大学移植中心使用病例对照匹配组的回顾性研究。1990 年 2 月 1 日至 2010 年 11 月 30 日期间，在加利福尼亚大学洛杉矶分校使用 DCD 器官进行 OLT 的所有 18 岁及以下的患者均与在 12 个月内接受 DBD 供体原发性 OLT 的患者按 1:3 的比例进行匹配。其他匹配标准包括受者年龄、体重、肝病病因和疾病严重程度。比较 DCD（n=7）和 DBD（n=21）供体的 OLT 后结局。OLT 的中位随访时间为 4.5 年。
主要结局指标是移植物无失败存活率；次要终点是缺血性胆管病的发生。
与 DCD 和 DBD 组相比，受者中位年龄（分别为 28.4 个月和 20.1 个月；P=0.80）、体重（分别为 12.0 千克和 11.6 千克；P=0.87）、终末期肝病/小儿终末期肝病模型评分（分别为 19 和 11，P=0.48）和供者年龄（分别为 24.0 个月和 13.1 个月，P=0.72）相似。DCD 供者的中位热缺血时间为 24 分钟。OLT 后 1 周和 3、6、12 个月，两组的肝功能检查结果相似。两组 DCD 和 DBD 的 10 年患者和移植物存活率均为 100%。DCD 组未发生缺血性胆管病或血管并发症。1 例 DCD 患者和 3 例 DBD 患者发生胆吻合口狭窄。
我们的研究表明，使用 DCD 器官进行儿童肝移植可获得出色的长期结果。使用循环死亡后获取的肝移植物是扩大供体库的有效方法，仍然是终末期肝病儿童的未开发资源。
