Ramirez P, Ferreras D, Febrero B, Royo M, Cascales P, Rodriguez J M, Rios A, Fernandez J A, González M R, Sanchez-Bueno F, Robles R, Parrilla P
Transplant Unit, General Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain, Instituto Murciano de Investigaciones Biomédicas (IMIB), Murcia, Spain.
Transplant Unit, General Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain, Instituto Murciano de Investigaciones Biomédicas (IMIB), Murcia, Spain.
Transplant Proc. 2018 Mar;50(2):601-604. doi: 10.1016/j.transproceed.2017.11.037.
Donation after circulatory death (DCD) has increased in the last decade, although a slight increase in surgical complications has been reported in liver transplantation (LT). Therefore, DCD is not recommended with donors aged 60 years or more because it entails an added risk. However, donation after brain death (DBD)-LT with donors aged 70 years or more shows acceptable results.
The objective was to analyze the characteristics and complications of DCD-LT with donors aged 70 years or more (DCD-70).
We included 14 DCD-70-LT and compared them with a control group of 28 DBD-LT aged 70 years or more.
A descriptive analysis, Mann-Whitney U test, and Pearson chi-square or Fisher test were performed when appropriate.
Significant differences were found in aminotransferase peak at 24 hours, with an increase in the DCD-70 group (aspartate aminotransferease [AST] 1038 vs 507, P = .013; alanine aminotransferase [ALT] 750 vs 399, P = .014). The cold ischemia time was lower in DCD-70 although without significant differences (4.8 vs 6.7 hours). Biliary complications (28.6% vs 31.7%) and vascular complications (7.1% vs 7.1%) were similar. A single transplant with DCD-70 required a retransplantation due to arterial thrombosis. Mortality was the same in both cases (14.3%).
LT results with DCD-70 are similar to those of DBD-70, so the age criteria could also be extended in this type of donation.
尽管有报道称肝移植（LT）手术并发症略有增加，但过去十年中循环死亡后器官捐献（DCD）有所增加。因此，不建议对60岁及以上的供体进行DCD，因为这会带来额外风险。然而，70岁及以上供体的脑死亡后器官捐献（DBD）-LT显示出可接受的结果。
分析70岁及以上供体的DCD-LT（DCD-70）的特征和并发症。
我们纳入了14例DCD-70-LT，并将其与28例70岁及以上的DBD-LT对照组进行比较。
进行描述性分析、Mann-Whitney U检验，并在适当情况下进行Pearson卡方检验或Fisher检验。
发现两组在术后24小时转氨酶峰值存在显著差异，DCD-70组有所升高（天冬氨酸转氨酶[AST]1038对507，P = 0.013；丙氨酸转氨酶[ALT]750对399，P = 0.014）。DCD-70的冷缺血时间较短，尽管无显著差异（4.8对6.7小时）。胆系并发症（28.6%对31.7%）和血管并发症（7.1%对7.1%）相似。1例DCD-70单例移植因动脉血栓形成需要再次移植。两组死亡率相同（14.3%）。
DCD-70的LT结果与DBD-70相似，因此在这类捐献中年龄标准也可放宽。
