控制性循环死亡（DCD）供体：关注儿科供体的利用和肺移植后的结果。
Controlled donation after circulatory death (DCD) donors: A focus on the utilization of pediatric donors and outcomes after lung transplantation.
机构信息
National Paediatric Lung Transplant Service and Adult Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Commonwealth of Australia.
National Paediatric Lung Transplant Service and Adult Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Commonwealth of Australia.
出版信息
J Heart Lung Transplant. 2019 Oct;38(10):1089-1096. doi: 10.1016/j.healun.2019.06.009. Epub 2019 Jun 19.
BACKGROUND
Access to timely suitably size-matched quality organs remains a challenge for pediatric (pLTx) and adult (aLTx) lung transplantation. The outcomes of donation after circulatory death (DCD) donor lungs from pediatric or adult donors are rarely reported.
METHODS
This report describes the controlled DCD and pLTx activity (≤ age 18 years) and outcomes since 2006 when DCD LTx started at our center at the Alfred Hospital.
RESULTS
Forty pLTx have been performed since 2006, 9 utilizing DCD and 31 donation after brain death (DBD) donors. A total of 22 pLTX have been conducted since 2012 (when DCD pLTx started); 9 DCD LTx (median age 15 years), including 4 pediatric DCD donors (mean age 8 years) and 5 adult (including 2 cutdown bilobar) DCD LTx donors (mean age 43 years). The other 13 pLTx utilized DBD donors - 8 pediatric (mean age 9 years) and 5 adult (including 2 cutdown bilobar) DBD LTx donors (mean age 44 years). One hundred percent survived 1 year, and 7 of 9 DCD pLTx (78%) are alive (median of 1,316 days), with one Chronic Lung Allograft Dysfunction (CLAD) death at 531 days and one renal failure death at 1,813 days. Three waiting list pediatric deaths occurred at 166 and 320 days. Since 2006, 77 pediatric donors have been used for LTx. Fifteen of these were DCD donors (median age 16 years), 11 of 15 have been used for aLTx (73%). Ten of 11 aLTx are alive at a median 1,992 days (91%) with 1 death at Day 2,444 from CLAD.
CONCLUSIONS
Controlled DCD provide a significant and quality donor lung pool to increase LTx opportunities for pediatric patients (and adults) with terminal lung disease.
背景
及时获得合适大小和质量的器官仍然是儿科（pLTx）和成人（aLTx）肺移植的挑战。来自儿科或成人供体的心跳停止后捐献（DCD）供肺的结果很少有报道。
方法
本报告描述了自 2006 年我们在阿尔弗雷德医院中心开始进行 DCD 肺移植以来，控制 DCD 和 pLTx 活动（≤18 岁）和结果。
结果
自 2006 年以来已经进行了 40 例 pLTx，其中 9 例使用 DCD，31 例使用脑死亡后捐献（DBD）供体。自 2012 年（开始进行 DCD pLTx 时）以来共进行了 22 例 pLTX；9 例 DCD LTx（中位年龄 15 岁），包括 4 例儿科 DCD 供体（平均年龄 8 岁）和 5 例成人（包括 2 例双侧劈开）DCD LTx 供体（平均年龄 43 岁）。另外 13 例 pLTx 使用 DBD 供体-8 例儿科（平均年龄 9 岁）和 5 例成人（包括 2 例双侧劈开）DBD LTx 供体（平均年龄 44 岁）。100%的患者存活 1 年，9 例 DCD pLTx 中有 7 例（78%）存活（中位时间为 1316 天），其中 1 例慢性肺移植物功能障碍（CLAD）死亡于 531 天，1 例肾衰竭死亡于 1813 天。3 例等待名单上的儿科患者分别于 166 天和 320 天死亡。自 2006 年以来，已有 77 例儿科供体用于 LTx。其中 15 例为 DCD 供体（中位年龄 16 岁），15 例中有 11 例用于 aLTx（73%）。11 例 aLTx 中有 10 例存活，中位时间为 1992 天（91%），其中 1 例于第 2444 天因 CLAD 死亡。
结论
控制 DCD 为终末期肺部疾病的儿科患者（和成人）提供了大量的高质量供肺池，增加了肺移植的机会。
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