Centre Hépato-Biliaire, Department of Hepatobiliary and Pancreatic Surgery and Transplantation, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Avenue Paul Vaillant Couturier, 94000, Villejuif, France.
Department of Hepatobiliary and Pancreatic Surgery and Transplantation, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
World J Surg. 2020 Mar;44(3):912-924. doi: 10.1007/s00268-019-05271-w.
The French transplant governing system defined "Rescue" (the so-called "Hors Tour") livers as those livers which were declined for the five top-listed patients. This study compares the outcomes following liver transplantation (LT) in patients who received a donor liver through a rescue allocation (RA) procedure or according to MELD score priority (standard allocation, SA) and evaluates the impact on the graft pool of a proactive policy to accept RA grafts.
Data from all consecutive patients who underwent LT with SA or RA grafts from 2011 to 2015 were compared in terms of short- and long-term outcomes.
The 249 elective first LTs were performed with 64 (25.7%) RA and 185 (74.3%) SA grafts. RA grafts were obtained from older donors and were associated with a longer cold ischemia time. Recipients of RA livers were older and had lower MELD scores. The rates of delayed graft function, primary nonfunction, retransplantation, complications, and mortality were similar between the RA and SA groups. At 1 and 3 and 5 years, graft and patient survival rates were similar between the groups. These results were maintained after matching on recipient characteristics. Our proactive policy to accept RA grafts increased the liver pool for elective first transplantation by 25%.
RA livers can be safely transplanted into selected recipients and significantly expand the liver pool.
法国移植管理系统将“抢救”（所谓的“ Hors Tour ”）肝脏定义为因五个最高优先级患者而被拒绝的肝脏。本研究比较了通过抢救性分配（RA）程序或根据 MELD 评分优先（标准分配，SA）接受供体肝脏进行肝移植（LT）的患者的结果，并评估了接受 RA 移植物的积极政策对移植物库的影响。
比较了 2011 年至 2015 年期间接受 SA 或 RA 移植物的连续所有患者的短期和长期结果。
249 例择期首次 LT 中有 64 例（25.7％）为 RA 移植物和 185 例（74.3％）SA 移植物。RA 移植物来自年龄较大的供体，并伴有较长的冷缺血时间。RA 肝脏受体年龄较大，MELD 评分较低。RA 和 SA 组之间的延迟移植物功能，原发性无功能，再次移植，并发症和死亡率相似。在 1 年，3 年和 5 年时，两组之间的移植物和患者存活率相似。在对受体特征进行匹配后，这些结果得以维持。我们接受 RA 移植物的积极政策将择期首次移植的肝脏库增加了 25％。
RA 肝脏可以安全地移植到选定的受体中，并可显著扩大肝脏库。
