Department of Surgery, Section of HPB Surgery and Liver Transplantation, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Surgery, Section of HPB Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands.
Transpl Int. 2020 Jun;33(6):667-674. doi: 10.1111/tri.13596. Epub 2020 Mar 9.
Due to the growing number of liver transplantations (LTs), there is an increasing number of patients requiring retransplantation (reLT). Data on the use of grafts from extended criteria donors (ECD), especially donation after circulatory death (DCD), for reLT are lacking. We aimed to assess the outcome of patients undergoing reLT using a DCD graft in the Netherlands between 2001 and July 2018. Propensity score matching was used to match each DCD-reLT with three DBD-reLT cases. Primary outcomes were patient and graft survival. Secondary outcome was the incidence of biliary complications, especially nonanastomotic strictures (NAS). 21 DCD-reLT were compared with 63 matched DBD-reLTs. Donors in the DCD-reLT group had a significantly lower BMI (22.4 vs. 24.7 kg/m , P-value = 0.02). Comparison of recipient demographics and ischemia times yielded no significant differences. Patient and graft survival rates were comparable between the two groups. However, the occurrence of nonanastomotic strictures after DCD-reLT was significantly higher (38.1% vs. 12.7%, P-value = 0.02). ReLT with DCD grafts does not result in inferior patient and graft survival compared with DBD grafts in selected patients. Therefore, DCD liver grafts should not routinely be declined for patients awaiting reLT.
由于肝移植（LT）数量的增加，需要进行再次肝移植（reLT）的患者数量也在不断增加。关于使用扩展标准供体（ECD），特别是心脏死亡后捐献（DCD）供体进行 reLT 的数据缺乏。我们旨在评估 2001 年至 2018 年 7 月期间荷兰使用 DCD 移植物进行 reLT 的患者的结局。采用倾向评分匹配法将每位 DCD-reLT 与 3 例 DBD-reLT 相匹配。主要结局是患者和移植物的存活率。次要结局是胆道并发症的发生率，特别是非吻合狭窄（NAS）。将 21 例 DCD-reLT 与 63 例匹配的 DBD-reLT 进行比较。DCD-reLT 组供体的 BMI 显著较低（22.4 对 24.7kg/m ，P 值=0.02）。两组受体的人口统计学和缺血时间比较无显著差异。两组患者和移植物的存活率相当。然而，DCD-reLT 后非吻合狭窄的发生率明显更高（38.1%对 12.7%，P 值=0.02）。在选定的患者中，与 DBD 移植物相比，DCD 移植物进行 reLT 并不会导致患者和移植物存活率降低。因此，对于等待 reLT 的患者，不应该常规拒绝使用 DCD 肝移植物。
