Division of Trauma, Surgical Critical Care and Acute Care Surgery, Harbor-UCLA Medical Center, Los Angeles, CA.
Division of Trauma, Surgical Critical Care and Acute Care Surgery, Harbor-UCLA Medical Center, Los Angeles, CA.
J Am Coll Surg. 2014 Oct;219(4):752-6. doi: 10.1016/j.jamcollsurg.2014.04.017. Epub 2014 Jun 2.
Refinements in donor management have resulted in increased numbers and quality of grafts after neurologic death. We hypothesize that the increased use of hormone replacement therapy (HRT) has been accompanied by improved outcomes over time.
Using the Organ Procurement and Transplant Network donor database, all brain-dead donors procured from July 1, 2001 to June 30, 2012 were studied. Hormone replacement therapy was identified by an infusion of thyroid hormone. An expanded criteria donor was defined as age 60 years or older. Incidence of HRT administration and number of donors and organs recovered were calculated. Using the Organ Procurement and Transplant Network thoracic recipient database transplant list, wait times were examined.
There were 74,180 brain-dead donors studied. Hormone replacement therapy use increased substantially from 25.6% to 72.3% of donors. However, mean number of organs procured per donor remained static (3.51 to 3.50; p = 0.083), and the rate of high-yield donors decreased (46.4% to 43.1%; p < 0.001). Incidence of traumatic brain injury donors decreased (42.1% to 33.9%; p < 0.001) relative to an increased number of expanded criteria donors (22.1% to 26%). Despite this, there has been an increase in the raw number of donors (20,558 to 24,308; p < 0.001) and organs (5,857 to 6,945; p < 0.001). There has been an increase in organs per traumatic brain injury donor (4.02 to 4.12; p = 0.002) and a decrease in days on the waiting list (462.2 to 170.4 days; p < 0.001) for a thoracic transplant recipient.
The marked increase in the use of HRT in the management of brain-dead donors has been accompanied by increased organ availability overall. Potential mechanisms might include successful conversion of previously unacceptable donors and improved recovery in certain subsets of donors.
神经死亡供体管理的改进导致了移植后移植物数量和质量的提高。我们假设，随着时间的推移，激素替代疗法（HRT）的使用增加，其结果也得到了改善。
利用器官获取和移植网络（OPTN）供体数据库，研究了 2001 年 7 月 1 日至 2012 年 6 月 30 日期间所有脑死亡供体。通过输注甲状腺激素来确定激素替代疗法的使用情况。将扩展标准供体定义为年龄 60 岁或以上。计算 HRT 给药的发生率、供体和器官恢复的数量。利用 OPTN 胸部分配受体数据库移植清单，检查等待时间。
共研究了 74180 名脑死亡供体。HRT 的使用率从 25.6%大幅增加到 72.3%。然而，每位供体采集的器官数量保持不变（3.51 至 3.50；p=0.083），高产供体的比例下降（46.4%至 43.1%；p<0.001）。创伤性脑损伤供体的发生率（42.1%至 33.9%；p<0.001）下降，而扩展标准供体的数量（22.1%至 26%）增加。尽管如此，供体（20558 至 24308；p<0.001）和器官（5857 至 6945；p<0.001）的数量都有所增加。创伤性脑损伤供体的器官数量有所增加（4.02 至 4.12；p=0.002），而胸部分配受体的等待时间减少（462.2 至 170.4 天；p<0.001）。
在脑死亡供体管理中，HRT 的使用明显增加，总体上增加了器官的可获得性。潜在的机制可能包括以前不可接受的供体的成功转化和某些供体亚组的恢复改善。
