Halazun Karim J, Quillin Ralph C, Rosenblatt Russel, Bongu Advaith, Griesemer Adam D, Kato Tomoaki, Smith Craig, Michelassi Fabrizio, Guarrera James V, Samstein Benjamin, Brown Robert S, Emond Jean C
*Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell School of Medicine, New York, NY †Center for Liver Disease and Transplantation, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY ‡Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY.
Ann Surg. 2017 Sep;266(3):441-449. doi: 10.1097/SLA.0000000000002383.
Marginal livers (ML) have been used to expand the donor pool. National utilization of MLs is variable, and in some centers, they are never used. We examined the outcomes of MLs in the largest single center series of MLs used to date and compared outcomes to standard (SL) and living donor (LD) livers.
Analysis of a prospectively maintained database of all liver transplants performed at our institution from 1998 to 2016. ML grafts were defined as livers from donors >70, livers discarded regionally and shared nationally, livers with cold ischemic time >12 hours, livers from hepatitis C virus positive donors, livers from donation after cardiac death donors, livers with >30% steatosis, and livers split between 2 recipients.
A total of 2050 liver transplant recipients were studied, of these 960 (46.8%) received ML grafts. ML recipients were more likely to have lower MELDs and have hepatocellular carcinoma. Most MLs used were from organs turned down regionally and shared nationally (69%) or donors >70 (22%). Survival of patients receiving MLs did not significantly differ from patients receiving SL grafts (P = 0.08). ML and SL recipients had worse survival than LDs (P < 0.01). Despite nearly half of our recipients receiving MLs, overall survival was significantly better than national survival over the same time period (P = 0.04). Waitlist mortality was significantly lower in our series compared with national results (19% vs 24.0%, P < 0.0001).
Outcomes of recipients of ML grafts are comparable to SL transplants. Despite liberal use of these grafts, we have been able to successfully reduce waitlist mortality while exceeding national post-transplant survival metrics.
边缘供肝（ML）已被用于扩大供体库。全国范围内对边缘供肝的利用情况各不相同，在一些中心，边缘供肝从未被使用过。我们在迄今最大的单中心边缘供肝系列研究中检查了边缘供肝的结局，并将其与标准供肝（SL）和活体供肝（LD）的结局进行比较。
对1998年至2016年在我们机构进行的所有肝移植的前瞻性维护数据库进行分析。边缘供肝移植物定义为来自年龄>70岁供体的肝脏、区域内废弃但在全国共享的肝脏、冷缺血时间>12小时的肝脏、丙型肝炎病毒阳性供体的肝脏、心脏死亡后供体的肝脏、脂肪变性>30%的肝脏以及在2名受者之间分割的肝脏。
共研究了2050例肝移植受者，其中960例（46.8%）接受了边缘供肝移植物。边缘供肝受者更有可能具有较低的终末期肝病模型（MELD）评分且患有肝细胞癌。使用的大多数边缘供肝来自区域内拒绝但在全国共享的器官（69%）或年龄>70岁的供体（22%）。接受边缘供肝的患者的生存率与接受标准供肝移植物的患者无显著差异（P = 0.08）。边缘供肝和标准供肝受者的生存率低于活体供肝受者（P < 0.01）。尽管我们近一半的受者接受了边缘供肝，但总体生存率在同一时期显著优于全国生存率（P = 0.04）。与全国结果相比，我们系列中的等待名单死亡率显著更低（19%对24.0%，P < 0.0001）。
边缘供肝移植物受者的结局与标准供肝移植相当。尽管广泛使用了这些移植物，但我们能够成功降低等待名单死亡率，同时超过全国移植后的生存指标。
