Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri.
Division of Transplantation, Department of Surgery, Mass General Hospital, Boston, Massachusetts.
Am J Transplant. 2019 May;19(5):1296-1304. doi: 10.1111/ajt.15129. Epub 2018 Oct 19.
Abdominal organ transplantation faces several challenges: burnout, limited pipeline of future surgeons, changes in liver allocation potentially impacting organ procurement travel, and travel safety. The organ procurement center (OPC) model may be one way to mitigate these issues. Liver transplants from 2009 to 2016 were reviewed. There were 755 liver transplants performed with 525 OPC and 230 in-hospital procurements. The majority of transplants (87.4%) were started during daytime hours (5 am-7 pm). Transplants with any portion occurring after-hours were more likely to have procurements in-hospital (P < .001). Daytime cases (n = 400) had more OPC procured livers and hepatitis C recipients and were less likely to have a donation after circulatory death donor (all P < .05). In adjusted analyses, daytime cases were independently associated with extubation in the operating room and less postoperative transfusion. There were no significant differences in short- or long-term postoperative outcomes. For exported livers, 54.3% were procured by a local team, saving 137 flights (151 559 miles). The OPC resulted in optimally timed liver transplants and decreased resource utilization with no negative impact on patient outcomes. It allows for ease in exporting organs procured by local surgeons, and potentially addresses provider burnout, the transplant surgery pipeline, and surgeon travel.
医生倦怠、未来外科医生人数有限、肝脏分配的变化可能影响器官获取的旅行,以及旅行安全。器官获取中心 (OPC) 模式可能是缓解这些问题的一种方法。回顾了 2009 年至 2016 年的肝脏移植数据。共有 755 例肝脏移植,其中 525 例来自 OPC,230 例来自院内获取。大多数移植(87.4%)发生在白天时段(5 点至 7 点)。任何时段过后进行的移植更有可能在院内进行获取(P<.001)。白天时段的病例(n=400)有更多 OPC 获取的肝脏和丙型肝炎受体,并且不太可能有循环死亡供体(所有 P<.05)。在调整分析中,白天时段的病例与在手术室拔管和术后输血减少独立相关。短期和长期术后结局没有显著差异。对于出口肝脏,54.3%是由当地团队获取的,节省了 137 个航班(151559 英里)。OPC 实现了最佳时间的肝脏移植,并减少了资源利用,对患者结局没有负面影响。它使得本地外科医生获取的器官更容易出口,并且可能解决提供者倦怠、移植手术管道和外科医生旅行问题。