Mittal Shruti, Gilbert James, Friend Peter J
aOxford Transplant Centre, Churchill Hospital bNuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
Curr Opin Organ Transplant. 2017 Aug;22(4):372-376. doi: 10.1097/MOT.0000000000000437.
The use of organs from donors after circulatory death (DCD) has become standard practice in solid organ transplantation of most abdominal organs and has been used successfully in some centres for pancreas transplantation. Nevertheless, concerns regarding poor graft outcomes and complications remain. This review aims to discuss the current state of DCD pancreas transplantation and the associated outcomes.
In many countries, whereas the number of donors after brainstem death (DBD) remains stable, the mean age and BMI have increased making these donors, previously considered to be low risk, now more marginal. Recent meta-analyses have confirmed previous single-centre and registry reports that graft and patient survival after DCD pancreas transplantation are comparable with outcomes using pancreases from DBD donors; DCD pancreas transplantation is now common practice in several countries in Europe, particularly the United Kingdom. Although there have been reports of higher thrombosis rates after DCD pancreas transplantation, the significance of this is difficult to judge as the impact has not been seen in overall graft survival.
Pancreas transplantation using DCD organs is well tolerated and feasible when other risk factors are minimized. Although there has been some evidence of an increased risk of thrombosis, this has not translated into a significant difference in graft survival.
在大多数腹部器官的实体器官移植中，使用来自心脏死亡后供体（DCD）的器官已成为标准做法，并且在一些中心已成功用于胰腺移植。然而，对移植物预后不良和并发症的担忧仍然存在。本综述旨在讨论DCD胰腺移植的现状及相关预后。
在许多国家，尽管脑死亡后供体（DBD）的数量保持稳定，但平均年龄和体重指数有所增加，这使得这些以前被认为是低风险的供体现在风险更高。最近的荟萃分析证实了先前的单中心和登记报告，即DCD胰腺移植后的移植物和患者存活率与使用DBD供体胰腺的结果相当；DCD胰腺移植目前在欧洲的几个国家，特别是英国，已成为常见做法。尽管有报道称DCD胰腺移植后血栓形成率较高，但由于总体移植物存活率未受影响，因此难以判断其意义。
当其他风险因素降至最低时，使用DCD器官进行胰腺移植耐受性良好且可行。尽管有一些证据表明血栓形成风险增加，但这并未转化为移植物存活率的显著差异。
