Parikh Neehar D, Skaro Anton I, Ladner Daniela P, Lyuksemburg Vadim, Cahan Joshua G, Daud Amna, Butt Zeeshan
Division of Gastroenterology, University of Michigan, Ann Arbor, MI 48109, USA ; Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL 60611, USA ; Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Northwestern University, Chicago, IL 60611, USA.
Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Northwestern University, Chicago, IL 60611, USA ; Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Gastroenterol Res Pract. 2015;2015:680316. doi: 10.1155/2015/680316. Epub 2015 Apr 1.
Donation after cardiac death (DCD) has expanded in the last decade in the US; however, DCD liver utilization has flattened in recent years due to poor outcomes. We examined clinical and quality of life (QOL) outcomes of DCD recipients by conducting a retrospective and cross-sectional review of patients from 2003 to 2010. We compared clinical outcomes of DCD recipients (n = 60) to those of donation after brain death (DBD) liver recipients (n = 669) during the same time period. DCD recipients had significantly lower rates of 5-year graft survival (P < 0.001) and a trend toward lower rates of 5-year patient survival (P = 0.064) when compared to the DBD cohort. In order to examine QOL outcomes in our cohorts, we administered the Short Form Liver Disease Quality of Life questionnaire to 30 DCD and 60 DBD recipients. The DCD recipients reported lower generic and liver-specific QOL. We further stratified the DCD cohort by the presence of ischemic cholangiopathy (IC). Patients with IC reported lower QOL when compared to DBD recipients and those DCD recipients without IC (P < 0.05). While the results are consistent with clinical experience, this is the first report of QOL in DCD recipients using standardized measures. These data can be used to guide future comparative effectiveness studies.
心脏死亡后器官捐献（DCD）在美国过去十年中有所增加；然而，由于效果不佳，近年来DCD肝脏的利用率趋于平稳。我们通过对2003年至2010年的患者进行回顾性和横断面研究，考察了DCD受者的临床和生活质量（QOL）结果。我们将同一时期DCD受者（n = 60）的临床结果与脑死亡后器官捐献（DBD）肝脏受者（n = 669）的临床结果进行了比较。与DBD队列相比，DCD受者的5年移植物存活率显著更低（P < 0.001），5年患者存活率有降低趋势（P = 0.064）。为了考察我们队列中的QOL结果，我们对30名DCD受者和60名DBD受者进行了肝病生活质量简表问卷调查。DCD受者报告的一般和肝脏特异性QOL较低。我们根据缺血性胆管病（IC）的有无对DCD队列进一步分层。与DBD受者以及没有IC的DCD受者相比，有IC的患者报告的QOL较低（P < 0.05）。虽然结果与临床经验一致，但这是首次使用标准化测量方法报告DCD受者的QOL。这些数据可用于指导未来的比较效果研究。
