Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD.
Transplantation. 2018 Jul;102(7):1148-1155. doi: 10.1097/TP.0000000000002082.
The donation of multiple allografts from a single living donor is a rare practice, and the patient characteristics and outcomes associated with these procedures are not well described.
Using the Scientific Registry of Transplant Recipients, we identified 101 living multiorgan donors and their 133 recipients.
The 49 sequential (donations during separate procedures) multiorgan donors provided grafts to 81 recipients: 21 kidney-then-liver, 15 liver-then-kidney, 5 lung-then-kidney, 3 liver-then-intestine, 3 kidney-then-pancreas, 1 lung-then-liver, and 1 pancreas-then-kidney. Of these donors, 38% donated 2 grafts to the same recipient and 15% donated 2 grafts as non-directed donors. Compared to recipients from first-time, single organ living donors, recipients from second-time living donors had similar graft and patient survival. The 52 simultaneous (multiple donations during one procedure) multiorgan donors provided 2 grafts to 1 recipient each: 48 kidney-pancreas and 4 liver-intestine. Donors had median of 13.4 years (interquartile range, 8.3-18.5 years) of follow-up. There was one reported death of a sequential donor (2.5 years after second donation). Few postdonation complications were reported over a median of 116 days (interquartile range, 0-295 days) of follow-up; however, routine living donor follow-up data were sparse. Recipients of kidneys from second-time living donors had similar graft (P = 0.2) and patient survival (P = 0.4) when compared with recipients from first-time living donors. Similarly, recipients of livers from second-time living donors had similar graft survival (P = 0.9) and patient survival (P = 0.7) when compared with recipients from first-time living donors.
Careful documentation of outcomes is needed to ensure ethical practices in selection, informed consent, and postdonation care of this unique donor community.
从单一活体供体捐献多个同种异体移植物的做法较为罕见，目前尚不清楚与这些手术相关的患者特征和结局。
我们利用移植受者科学注册处（Scientific Registry of Transplant Recipients）的数据，确定了 101 名活体多器官捐献者及其 133 名受者。
49 例连续（在不同手术中进行的捐献）多器官捐献者为 81 名受者提供了移植物：21 例为肾-肝序贯移植，15 例为肝-肾序贯移植，5 例为肺-肾序贯移植，3 例为肝-肠序贯移植，3 例为肾-胰序贯移植，1 例为肺-肝序贯移植，1 例为胰-肾序贯移植。其中，38%的捐献者将 2 个移植物捐给了同一名受者，15%的捐献者作为非定向捐献者捐出 2 个移植物。与首次接受活体单器官捐献的受者相比，再次接受活体捐献者的移植物和患者存活率相似。52 例同时（在一次手术中进行多次捐献）多器官捐献者为每位受者各提供了 2 个移植物：48 例为肾-胰，4 例为肝-肠。供者中位随访时间为 13.4 年（四分位距，8.3-18.5 年）。报告了 1 例序贯捐献者死亡（在第二次捐献后 2.5 年）。中位随访 116 天（四分位距，0-295 天）期间报告了少数几例捐献后并发症；然而，常规活体供者随访数据较为缺乏。与首次接受活体供者的受者相比，再次接受活体供者捐献的肾脏受者的移植物存活率（P=0.2）和患者存活率（P=0.4）相似。同样，再次接受活体供者捐献的肝脏受者的移植物存活率（P=0.9）和患者存活率（P=0.7）与首次接受活体供者的受者相似。
需要仔细记录结局，以确保在选择、知情同意和捐献后护理方面符合该独特供者群体的伦理规范。
