Mangus Richard S, Schroering Joel R, Fridell Jonathan A, Kubal Chandrashekhar A
Transplant Division, Department of Surgery, Indiana University, School of Medicine, Indianapolis, IN, USA.
Ann Transplant. 2018 Nov 20;23:808-814. doi: 10.12659/AOT.910387.
BACKGROUND Transplantation of liver grafts from deceased donors who experienced cardiac arrest prior to liver procurement is now common. This single-center study analyzed the impact of pre-donation arrest time on clinical outcomes in liver transplantation. MATERIAL AND METHODS Records of all orthotopic liver transplants performed at a single center over a 15-year period were reviewed. Donor records were reviewed and total arrest time was calculated as cumulative minutes. Post-transplant liver graft function was assessed using laboratory values. Graft survival was assessed with Cox regression analysis. RESULTS Records for 1830 deceased donor transplants were reviewed, and 521 donors experienced pre-procurement cardiac arrest (28%). Median arrest time was 21 min (mean 25 min, range 1-120 min). After transplant, the peak alanine aminotransferase and bilirubin levels for liver grafts from donors with arrest were lower compared to those for donors without arrest (p<0.001). Early allograft dysfunction occurred in 25% (arrest) and 28% (no arrest) of patients (p=0.22). There were no differences in risk of early graft loss (3% vs. 3%, p=0.84), length of hospital stay (10 vs. 10 days, p=0.76), and 1-year graft survival (89% vs. 89%, p=0.94). Cox regression analysis comparing 4 groups (no arrest, <20 min, 20-40 min, and >40 min arrest) demonstrated no statistically significant difference in survival at 10 years. Subgroup analysis of 93 donation after cardiac death grafts showed no significant difference for these same outcomes. CONCLUSIONS These results support the use of select deceased liver donors who experience pre-donation cardiac arrest. Pre-donation arrest may be associated with less early allograft dysfunction, but had no impact on long-term clinical outcomes. The results for donation after cardiac death donors were similar.
背景 目前，使用在肝脏获取前经历心脏骤停的已故供体的肝脏移植物进行移植已很常见。这项单中心研究分析了捐赠前心脏骤停时间对肝移植临床结果的影响。
材料与方法 回顾了在一个单中心15年期间进行的所有原位肝移植记录。查阅供体记录并计算总骤停时间（以累计分钟数计）。使用实验室值评估移植后肝移植物功能。通过Cox回归分析评估移植物存活率。
结果 回顾了1830例已故供体移植的记录，521例供体在获取前经历了心脏骤停（28%）。中位骤停时间为21分钟（平均25分钟，范围1 - 120分钟）。移植后，经历骤停的供体的肝移植物的峰值丙氨酸转氨酶和胆红素水平低于未经历骤停的供体（p<0.001）。25%（经历骤停）和28%（未经历骤停）的患者发生早期移植物功能障碍（p = 0.22）。早期移植物丢失风险（3%对3%，p = 0.84）、住院时间（10天对10天，p = 0.76）和1年移植物存活率（89%对89%，p = 0.94）无差异。比较4组（未经历骤停、<20分钟、20 - 40分钟和>40分钟骤停）的Cox回归分析显示，10年生存率无统计学显著差异。对93例心脏死亡后捐赠的移植物进行亚组分析，这些相同结果无显著差异。
结论 这些结果支持使用在捐赠前经历心脏骤停的特定已故肝脏供体。捐赠前心脏骤停可能与较少的早期移植物功能障碍相关，但对长期临床结果无影响。心脏死亡后捐赠供体的结果相似。
