Bronchard Régis, Durand Louise, Legeai Camille, Cohen Johana, Guerrini Patrice, Bastien Olivier
1Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Malakoff, France. 2Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis, France. 3Service d'Anesthésie-Réanimation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France.
Crit Care Med. 2017 Oct;45(10):1734-1741. doi: 10.1097/CCM.0000000000002564.
To describe donors after brain death with ongoing extracorporeal membrane oxygenation and to analyze the outcome of organs transplanted from these donors.
Retrospective analysis of the national information system run by the French Biomedicine Agency (CRISTAL database).
National registry data of all donors after brain death in France and their organ recipients between 2007 and 2013.
Donors after brain death and their organ recipients.
None.
During the study period, there were 22,270 brain-dead patients diagnosed in France, of whom 161 with extracorporeal membrane oxygenation. Among these patients, 64 donors on extracorporeal membrane oxygenation and 10,805 donors without extracorporeal membrane oxygenation had at least one organ retrieved. Donors on extracorporeal membrane oxygenation were significantly younger and had more severe intensive care medical conditions (hemodynamic, biological, renal, and liver insults) than donors without extracorporeal membrane oxygenation. One hundred nine kidneys, 37 livers, seven hearts, and one lung were successfully transplanted from donors on extracorporeal membrane oxygenation. We found no significant difference in 1-year kidney graft survival (p = 0.24) and function between recipients from donors on extracorporeal membrane oxygenation (92.7% [85.9-96.3%]) and matching recipients from donors without extracorporeal membrane oxygenation (95.4% [93.0-97.0%]). We also found no significant difference in 1-year liver recipient survival (p = 0.91): 86.5% (70.5-94.1) from donors on extracorporeal membrane oxygenation versus 80.7% (79.8-81.6) from donors without extracorporeal membrane oxygenation.
Brain-dead patients with ongoing extracorporeal membrane oxygenation have more severe medical conditions than those without extracorporeal membrane oxygenation. However, kidney graft survival and function were no different than usual. Brain-dead patients with ongoing extracorporeal membrane oxygenation are suitable for organ procurement.
描述在进行体外膜肺氧合（ECMO）时脑死亡后的供体，并分析从这些供体移植器官的结果。
对法国生物医学机构运行的国家信息系统（CRISTAL数据库）进行回顾性分析。
法国2007年至2013年间所有脑死亡后供体及其器官接受者的国家登记数据。
脑死亡后供体及其器官接受者。
无。
在研究期间，法国有22270例脑死亡患者被诊断，其中161例接受了体外膜肺氧合。在这些患者中，64例接受体外膜肺氧合的供体和10805例未接受体外膜肺氧合的供体至少有一个器官被获取。接受体外膜肺氧合的供体比未接受体外膜肺氧合的供体明显更年轻，且有更严重的重症监护医疗状况（血流动力学、生物学、肾脏和肝脏损伤）。109个肾脏、37个肝脏、7颗心脏和1个肺成功地从接受体外膜肺氧合的供体移植。我们发现接受体外膜肺氧合的供体的受者与匹配的未接受体外膜肺氧合的供体的受者在1年肾移植存活率（p = 0.24）和功能方面没有显著差异（接受体外膜肺氧合的供体的受者为92.7% [85.9 - 96.3%]，未接受体外膜肺氧合的供体的受者为95.4% [93.0 - 97.0%]）。我们还发现1年肝移植受者存活率（p = 0.91）没有显著差异：接受体外膜肺氧合的供体的受者为86.5%（70.5 - 94.1），未接受体外膜肺氧合的供体的受者为80.7%（79.8 - 81.6）。
正在进行体外膜肺氧合的脑死亡患者的医疗状况比未进行体外膜肺氧合的患者更严重。然而，肾移植存活率和功能与通常情况无异。正在进行体外膜肺氧合的脑死亡患者适合进行器官获取。
