Blok Joris J, Detry Olivier, Putter Hein, Rogiers Xavier, Porte Robert J, van Hoek Bart, Pirenne Jacques, Metselaar Herold J, Lerut Jan P, Ysebaert Dirk K, Lucidi Valerio, Troisi Roberto I, Samuel Undine, den Dulk A Claire, Ringers Jan, Braat Andries E
Department of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden University, Leiden, the Netherlands.
Department of Abdominal Surgery and Transplantation, University Hospital of Liège, Liège, Belgium.
Liver Transpl. 2016 Aug;22(8):1107-14. doi: 10.1002/lt.24449.
Donation after circulatory death (DCD) liver transplantation (LT) may imply a risk for decreased graft survival, caused by posttransplantation complications such as primary nonfunction or ischemic-type biliary lesions. However, similar survival rates for DCD and donation after brain death (DBD) LT have been reported. The objective of this study is to determine the longterm outcome of DCD LT in the Eurotransplant region corrected for the Eurotransplant donor risk index (ET-DRI). Transplants performed in Belgium and the Netherlands (January 1, 2003 to December 31, 2007) in adult recipients were included. Graft failure was defined as either the date of recipient death or retransplantation whichever occurred first (death-uncensored graft survival). Mean follow-up was 7.2 years. In total, 126 DCD and 1264 DBD LTs were performed. Kaplan-Meier survival analyses showed different graft survival for DBD and DCD at 1 year (77.7% versus 74.8%, respectively; P = 0.71), 5 years (65.6% versus 54.4%, respectively; P = 0.02), and 10 years (47.3% versus 44.2%, respectively; P = 0.55; log-rank P = 0.038). Although there was an overall significant difference, the survival curves almost reach each other after 10 years, which is most likely caused by other risk factors being less in DCD livers. Patient survival was not significantly different (P = 0.59). Multivariate Cox regression analysis showed a hazard ratio of 1.7 (P < 0.001) for DCD (corrected for ET-DRI and recipient factors). First warm ischemia time (WIT), which is the time from the end of circulation until aortic cold perfusion, over 25 minutes was associated with a lower graft survival in univariate analysis of all DCD transplants (P = 0.002). In conclusion, DCD LT has an increased risk for diminished graft survival compared to DBD. There was no significant difference in patient survival. DCD allografts with a first WIT > 25 minutes have an increased risk for a decrease in graft survival. Liver Transplantation 22 1107-1114 2016 AASLD.
心脏死亡后器官捐献（DCD）肝移植（LT）可能意味着移植物存活降低的风险，这是由移植后并发症如原发性无功能或缺血型胆管病变引起的。然而，已有报道称DCD肝移植和脑死亡后器官捐献（DBD）肝移植的存活率相似。本研究的目的是确定在欧洲移植区域校正欧洲移植供体风险指数（ET-DRI）后DCD肝移植的长期结果。纳入了在比利时和荷兰（2003年1月1日至2007年12月31日）对成年受者进行的移植。移植物失败定义为受者死亡或再次移植的日期，以先发生者为准（死亡未删失的移植物存活）。平均随访时间为7.2年。总共进行了126例DCD肝移植和1264例DBD肝移植。Kaplan-Meier生存分析显示，DBD和DCD在1年时的移植物存活率不同（分别为77.7%和74.8%；P = 0.71），5年时（分别为65.6%和54.4%；P = 0.02），以及10年时（分别为47.3%和44.2%；P = 0.55；对数秩检验P = 0.038）。虽然总体上存在显著差异，但10年后生存曲线几乎相交，这很可能是由于DCD肝脏中其他风险因素较少。患者存活率无显著差异（P = 0.59）。多变量Cox回归分析显示，DCD的风险比为1.7（P < 0.001）（校正了ET-DRI和受者因素）。在所有DCD移植的单变量分析中，首次热缺血时间（WIT），即从循环结束到主动脉冷灌注的时间，超过25分钟与较低的移植物存活率相关（P = 0.002）。总之，与DBD相比，DCD肝移植移植物存活降低的风险增加。患者存活率无显著差异。首次WIT>25分钟的DCD同种异体移植物移植物存活降低的风险增加。《肝脏移植》2016年第22卷1107 - 1114页美国肝脏病研究协会
