功能性热缺血时间对脑死亡后器官捐献肝移植受者预后的影响。

The influence of functional warm ischemia time on DCD liver transplant recipients' outcomes.

作者信息

Coffey Jessica C, Wanis Kerollos N, Monbaliu Diethard, Gilbo Nicholas, Selzner Markus, Vachharajani Neeta, Levstik Mark A, Marquez Max, Doyle Maria B Majella, Pirenne Jacques, Grant David, Heimbach Julie K, Chapman William, Vogt Kelly, Hernandez-Alejandro Roberto

机构信息

Division of General Surgery, Western University, London, ON, Canada.

Abdominal Transplant Surgery, University Hospitals Leuven & Department of Microbiology and Immunology, KU Leuven, Belgium.

出版信息

Clin Transplant. 2017 Oct;31(10). doi: 10.1111/ctr.13068. Epub 2017 Aug 29.

DOI:10.1111/ctr.13068

PMID:28772351

Abstract

BACKGROUND

Duration of functional warm ischemia (f-WIT) is thought to have a causal effect on outcomes in controlled donation after circulatory death (DCD) liver transplantation (LT).

METHODS

A retrospective cohort study was conducted at five centers. Data were extracted on donor and recipient characteristics, with attention to parameters recorded during withdrawal of life support to in situ cold perfusion. F-WIT was the time elapsed from any of the hemodynamic and oxygenation parameters to the start of in situ cold perfusion. Parameters were as follows: MAP ≤ 50 mm Hg; SBP ≤ 50 mm Hg; and SPO2 ≤ 60%. The primary endpoint was a composite of disseminated ischemic cholangiopathy (IC), primary non-function (PNF), and early graft failure.

RESULTS

35 patients (14%) developed one or more of the primary outcomes. On univariate analysis, older donors and longer WITs were associated with greater likelihood of complications. Of the f-WIT variations analyzed, only f-WIT with SpO2 ≤ 60% was longer among patients with complications. On multivariate analysis, only donor age was a significant predictor of complications.

CONCLUSION

This study demonstrates that, of the f-WITs, f-WIT with SpO2 ≤ 60% is most predictive of post-DCD complications. However, results suggest that there may be an alternate etiology for poor outcomes, and that donor age plays a key role.

摘要

背景

功能性热缺血（f-WIT）的持续时间被认为对心脏死亡后器官捐献（DCD）肝移植（LT）的结果有因果影响。

方法

在五个中心进行了一项回顾性队列研究。提取了供体和受体特征的数据，特别关注从撤除生命支持到原位冷灌注期间记录的参数。F-WIT是从任何血流动力学和氧合参数到原位冷灌注开始所经过的时间。参数如下：平均动脉压（MAP）≤50mmHg；收缩压（SBP）≤50mmHg；血氧饱和度（SPO2）≤60%。主要终点是弥散性缺血性胆管病（IC）、原发性无功能（PNF）和早期移植物功能衰竭的综合指标。