Croome Kristopher P, Lee David D, Perry Dana K, Burns Justin M, Nguyen Justin H, Keaveny Andrew P, Taner C Burcin
Department of Transplant, Mayo Clinic Florida, Jacksonville, FL.
Liver Transpl. 2017 Mar;23(3):342-351. doi: 10.1002/lt.24713.
The use of liver grafts from donation after cardiac death (DCD) has been limited due to the increased rate of graft failure, mostly related to ischemic cholangiopathy (IC). It is our hypothesis that longterm outcomes and quality of life (QOL) similar to patients undergoing liver transplantation (LT) with donation after brain death (DBD) can be achieved. Clinical outcomes of all patients undergoing DCD LT (n = 300) between 1998 and 2015 were compared with a propensity score-matched cohort of patients undergoing DBD LT (n = 300). Patients were contacted for a follow-up questionnaire and short-form (SF)-12 QOL Survey administration. Median follow-up was >5 years. Graft survival at 1-, 3-, and 5-years was 83.8%, 75.5%, and 70.1% in the DCD LT group and 88.4%, 80.3%, and 73.9% in the DBD LT group (P = 0.27). Patient survival at 1-, 3-, and 5-years was 92.3%, 86.1%, and 80.3% in the DCD LT group and 92.3%, 85.1%, and 79.5% in the DBD LT group (P = 0.81). IC developed in 11.7% and 2% of patients in the DCD LT group and DBD LT group, respectively (P < 0.001). DCD LT recipients who developed IC had inferior graft survival compared with both the DCD non-IC group (P < 0.001) and the DBD LT group (P < 0.001); no difference in graft survival was observed between the DCD non-IC group and the DBD LT group (P = 0.50). Physical and Mental Composite Scores on the SF-12 QOL questionnaire were similar between the DCD LT and DBD LT groups (44.0 versus 45.4; P = 0.34 and 51.9 versus 52.2; P = 0.83), respectively. Similar longterm survival and QOL scores can be achieved between DCD LT and DBD LT. Prevention of IC in DCD LT yields excellent graft and patient survival with virtually no difference compared with DBD LT. Liver Transplantation 23 342-351 2017 AASLD.
由于移植肝失功发生率增加，主要与缺血性胆管病（IC）相关，心脏死亡后捐赠（DCD）肝移植的应用一直受到限制。我们的假设是，DCD肝移植患者能够取得与脑死亡后捐赠（DBD）肝移植患者相似的长期预后和生活质量（QOL）。将1998年至2015年间所有接受DCD肝移植的患者（n = 300）的临床结局与倾向评分匹配的接受DBD肝移植的患者队列（n = 300）进行比较。对患者进行随访问卷调查并进行简短形式（SF）-12 QOL调查。中位随访时间>5年。DCD肝移植组1年、3年和5年的移植肝生存率分别为83.8%、75.5%和70.1%，DBD肝移植组分别为88.4%、80.3%和73.9%（P = 0.27）。DCD肝移植组1年、3年和5年的患者生存率分别为92.3%、86.1%和80.3%，DBD肝移植组分别为92.3%、85.1%和79.5%（P = 0.81）。DCD肝移植组和DBD肝移植组分别有11.7%和2%的患者发生IC（P < 0.001）。发生IC的DCD肝移植受者的移植肝生存率低于DCD非IC组（P < 0.001）和DBD肝移植组（P < 0.001）；DCD非IC组和DBD肝移植组之间未观察到移植肝生存率的差异（P = 0.50）。DCD肝移植组和DBD肝移植组SF-12 QOL问卷的身体和心理综合评分相似（分别为44.0对45.4；P = 0.34和51.9对52.2；P = 0.83）。DCD肝移植和DBD肝移植之间可实现相似的长期生存率和QOL评分。预防DCD肝移植中的IC可使移植肝和患者获得极佳的生存率，与DBD肝移植相比几乎没有差异。《肝脏移植》2017年第23卷第342 - 351页，美国肝脏病研究协会
