Martinez-Insfran L A, Ramirez P, Cascales P, Alconchel F, Ferreras D, Febrero B, Martinez M, González M R, Sanchez-Bueno F, Robles R, Parrilla P
General and Digestive Surgery Department, University Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain.
General and Digestive Surgery Department, University Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain.
Transplant Proc. 2019 Mar;51(2):359-364. doi: 10.1016/j.transproceed.2018.10.021. Epub 2018 Oct 29.
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 overall recommended because it entails an added risk. However, DCD in selected patients shows acceptable results.
The objective was to analyze the characteristics, early outcomes, and survival at 1 year post-LT from a single institute (January 2015 to May 2017).
We included 18 DCD-LTs and compared them with a control group of 18 donation after brain death (DBD) LTs. We analyzed pre- and posttransplant variables related to donors, recipients, and intraoperative early outcomes within patients transplanted due to hepatocellular carcinoma (HCC). A descriptive analysis, Mann-Whitney U test, χ, or Fisher test was performed when appropriate, as well as multivariate analysis in case of statistical significance. A variable is considered as statistically significant when it reaches a value of P < .05.
In DBD, we found a lower length of stay in the intensive care unit before retrieval and a higher rate of alcoholism and diabetes mellitus, Model for End-Stage Liver Disease score, and Child B and C score (P < .05). Most of the DCD were originally from the same LT recipient center, and a higher donor mean post-LT alanine aminotransferase level was found (P < .05). Survival for the DBD group was 88% and 75% in the DCD group at 1 year post-LT, being not significant (NS).
HCC recipients who are transplanted with good quality DCD livers do no worse than those transplanted with livers from DBD donors, although a good selection of them is crucial.
尽管有报道称肝移植（LT）的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）的数量有所增加。因此，由于存在额外风险，总体上不推荐DCD。然而，特定患者的DCD显示出可接受的结果。
分析来自单一机构（2015年1月至2017年5月）LT术后1年的特征、早期结局和生存率。
我们纳入了18例DCD-LT，并将其与18例脑死亡后器官捐献（DBD）LT的对照组进行比较。我们分析了与肝细胞癌（HCC）导致的移植患者的供体、受体和术中早期结局相关的移植前和移植后变量。在适当的时候进行描述性分析、Mann-Whitney U检验、χ²检验或Fisher检验，如有统计学意义则进行多变量分析。当P值 < 0.05时，变量被认为具有统计学意义。
在DBD组中，我们发现获取前在重症监护病房的住院时间较短，酒精中毒、糖尿病、终末期肝病模型评分以及Child B和C评分的发生率较高（P < 0.
