Schroering Joel R, Mangus Richard S, Powelson John A, Fridell Jonathan A
Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
Transplant Direct. 2018 Aug 21;4(9):e381. doi: 10.1097/TXD.0000000000000813. eCollection 2018 Sep.
Transplantation of pancreas allografts from donors that have experienced preprocurement cardiopulmonary arrest (PPCA) is not common, though use of PPCA grafts is routine in liver and kidney transplantation. This article reviews a large number of PPCA pancreas grafts at a single center and reports posttransplant outcomes including early graft dysfunction, length of hospital stay, rejection, and early and late graft survival.
Preprocurement cardiopulmonary arrest, arrest time, and donor and recipient pancreatic enzyme levels were collected from electronic and written medical records. The PPCA donors were stratified into 4 groups: none, less than 20 minutes, 20-39 minutes, and 40 minutes or greater. Graft survival was assessed at 7 and 90 days and at 1 year. Long-term graft survival was assessed by Cox regression analysis.
The records of 606 pancreas transplants were reviewed, including 328 (54%) simultaneous pancreas and kidney transplants. Preprocurement cardiopulmonary arrest occurred in 176 donors (29%; median time, 20 minutes). Median peak donor lipase was higher in PPCA donors (40 μ/L vs 29 μ/L, = 0.02). Posttransplant, peak recipient amylase, and lipase levels were similar ( = 0.63). Prolonged arrest time (>40 minutes) was associated with higher donor peak lipase and lower recipient peak amylase ( = 0.05 for both). Stratified by donor arrest time, there was no difference in 7-day, 90-day, or 1-year graft survival. Cox regression comparing the 4 groups demonstrated no statistical difference in 10-year survival.
These results support transplantation of pancreas allografts from PPCA donors. Prolonged asystole was associated with higher peak donor serum lipase but lower peak recipient serum amylase. There were no differences in allograft survival.
来自经历过获取前心肺骤停（PPCA）的供体的胰腺移植并不常见，尽管在肝脏和肾脏移植中使用PPCA供体的移植物是常规操作。本文回顾了单一中心的大量PPCA胰腺移植物，并报告了移植后的结果，包括早期移植物功能障碍、住院时间、排斥反应以及早期和晚期移植物存活情况。
从电子和书面病历中收集获取前心肺骤停、骤停时间以及供体和受体的胰腺酶水平。PPCA供体被分为4组：无、少于20分钟、20 - 39分钟以及40分钟或更长时间。在7天、90天和1年时评估移植物存活情况。通过Cox回归分析评估长期移植物存活情况。
回顾了606例胰腺移植记录，其中包括328例（54%）胰肾联合移植。176例供体（29%；中位时间为20分钟）发生了获取前心肺骤停。PPCA供体的供体脂肪酶峰值中位数更高（40 μ/L对29 μ/L，P = 0.02）。移植后，受体淀粉酶和脂肪酶峰值水平相似（P = 0.63）。骤停时间延长（>40分钟）与供体脂肪酶峰值升高和受体淀粉酶峰值降低相关（两者P均 = 0.05）。按供体骤停时间分层后，7天、90天或1年的移植物存活情况无差异。比较4组的Cox回归显示10年存活情况无统计学差异。
这些结果支持使用PPCA供体的胰腺移植。心脏停搏时间延长与供体血清脂肪酶峰值升高但受体血清淀粉酶峰值降低相关。移植物存活情况无差异。
