Department of Transplant, Mayo Clinic Florida, Jacksonville, FL.
Am J Transplant. 2017 Sep;17(9):2420-2427. doi: 10.1111/ajt.14383. Epub 2017 Jul 7.
Understanding of outcomes for patients relisted for ischemic cholangiopathy following a donation after cardiac death (DCD) liver transplant (LT) will help standardization of a Model for End-Stage Liver Disease exception scheme for retransplantation. Early relisting (E-RL) for DCD graft failure caused by primary nonfunction (PNF) or hepatic artery thrombosis (HAT) was defined as relisting ≤14 days after DCD LT, and late relisting (L-RL) due to biliary complications was defined as relisting 14 days to 3 years after DCD LT. Of 3908 DCD LTs performed nationally between 2002 and 2016, 540 (13.8%) patients were relisted within 3 years of transplant (168 [4.3%] in the E-RL group, 372 [9.5%] in the L-RL group). The E-RL and L-RL groups had waitlist mortality rates of 15.4% and 10.5%, respectively, at 3 mo and 16.1% and 14.3%, respectively, at 1 year. Waitlist mortality in the L-RL group was higher than mortality and delisted rates for patients with exception points for both hepatocellular carcinoma (HCC) and hepatopulmonary syndrome (HPS) at 3- to 12-mo time points (p < 0.001). Waitlist outcomes differed in patients with early DCD graft failure caused by PNF or HAT compared with those with late DCD graft failure attributed to biliary complications. In L-RL, higher rates of waitlist mortality were noted compared with patients listed with exception points for HCC or HPS.
对于接受心脏死亡后捐献（DCD）肝脏移植（LT）的患者，了解因缺血性胆管病而再次移植的结果将有助于终末期肝病模型（MELD）例外方案的标准化。早期再移植（E-RL）是指因原发性无功能（PNF）或肝动脉血栓形成（HAT）引起的 DCD 移植物失败而在 DCD LT 后 14 天内进行的再移植，晚期再移植（L-RL）是指因胆系并发症引起的 14 天至 3 年后进行的再移植。在 2002 年至 2016 年期间，全国范围内进行了 3908 例 DCD LT，其中 540 例（13.8%）患者在移植后 3 年内再次被列入名单（E-RL 组 168 例[4.3%]，L-RL 组 372 例[9.5%]）。E-RL 和 L-RL 组患者在 3 个月时的等待名单死亡率分别为 15.4%和 10.5%，在 1 年时分别为 16.1%和 14.3%。L-RL 组患者的等待名单死亡率高于在 3 至 12 个月时间点因肝细胞癌（HCC）和肝肺综合征（HPS）例外点而被列入名单的患者的死亡率和除名率（p <0.001）。在因 PNF 或 HAT 引起的早期 DCD 移植物衰竭的患者与因胆系并发症引起的晚期 DCD 移植物衰竭的患者相比，等待名单结果不同。在 L-RL 中，与因 HCC 或 HPS 而列入例外名单的患者相比，等待名单死亡率较高。
