de Boer Jacob D, Kopp Wouter H, Ooms Kirsten, Haase-Kromwijk Bernadette J, Krikke Christina, de Jonge Jeroen, van Heurn L W Ernst, Baranski Andre G, van der Vliet J Adam, Braat Andries E
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Dutch Transplant Foundation, Leiden, The Netherlands.
Transpl Int. 2017 Mar;30(3):288-294. doi: 10.1111/tri.12906. Epub 2017 Feb 8.
Between March 2012 and August 2013, 591 quality forms were filled out for abdominal organs in the Netherlands. In 133 cases (23%), there was a discrepancy between the evaluation from the procuring and transplanting surgeons. Injuries were seen in 148 (25%) organs of which 12 (2%) led to discarding of the organ: one of 133 (0.8%) livers, five of 38 (13%) pancreata and six of 420 (1.4%) kidneys (P < 0.001). Higher donor BMI was a risk factor for procurement-related injury in all organs (OR: 1.06, P = 0.011) and donor after cardiac death (DCD) donation in liver procurement (OR: 2.31, P = 0.034). DCD donation is also associated with more pancreata being discarded due to injury (OR: 10.333, P = 0.046). A higher procurement volume in a centre was associated with less injury in pancreata (OR = -0.95, P = 0.013) and kidneys (OR = -0.91, P = 0.012). The quality form system efficiently monitors the quality of organ procurement. Although there is a relatively high rate of organ injury, the discard rate is low and it does not significantly affect 1-year graft survival for any organ. We identified higher BMI as a risk factor for injury in abdominal organs and DCD as a risk factor in livers. A higher procurement volume is associated with fewer injuries.
2012年3月至2013年8月期间，荷兰共填写了591份腹部器官质量评估表。在133例（23%）病例中，获取器官的外科医生与移植外科医生的评估存在差异。148个（25%）器官出现损伤，其中12个（2%）导致器官被废弃：133个肝脏中有1个（0.8%），38个胰腺中有5个（13%），420个肾脏中有6个（1.4%）（P<0.001）。供体体重指数较高是所有器官获取相关损伤的危险因素（比值比：1.06，P=0.011），在肝脏获取中，心脏死亡后供体（DCD）捐献也是危险因素（比值比：2.31，P=0.034）。DCD捐献还与更多胰腺因损伤而被废弃有关（比值比：10.333，P=0.046）。中心较高的获取量与胰腺（比值比=-0.95，P=0.013）和肾脏（比值比=-0.91，P=0.012）损伤较少有关。质量评估表系统有效地监测了器官获取的质量。虽然器官损伤率相对较高，但废弃率较低，且对任何器官的1年移植存活率均无显著影响。我们确定较高的体重指数是腹部器官损伤的危险因素，DCD是肝脏损伤的危险因素。较高的获取量与较少的损伤有关。
