Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Clin Transplant. 2020 May;34(5):e13835. doi: 10.1111/ctr.13835. Epub 2020 Mar 23.
No standard exists for the use of deceased donor liver biopsy during procurement. We sought to evaluate liver biopsy and the impact of findings on outcomes and graft utilization.
A prospective observational study of donors after neurologic determination of death was conducted from 02/2012-08/2017 (16 OPOs). Donor data were collected through the UNOS Donor Management Goals Registry Web Portal and linked to the Scientific Registry of Transplant Recipients (SRTR) for recipient outcomes. Recipients of biopsied donor livers (BxDL) were studied and a Cox proportional hazard analysis was used to identify independent predictors of 1-year graft survival.
Data from 5449 liver transplant recipients were analyzed, of which 1791(33%) received a BxDL. There was no difference in graft or patient survival between the non-BxDL and BxDL recipient groups. On adjusted analysis of BxDL recipients, macrosteatosis (21%-30%[n = 148] and >30%[n = 92]) was not found to predict 1-year graft survival, whereas increasing donor age (HR1.02), donor Hispanic ethnicity (HR1.62), donor INR (HR1.18), and recipient life support (HR2.29) were.
Excellent graft and patient survival can be achieved in recipients of BxDL grafts. Notably, as demonstrated by the lack of effect of macrosteatosis on survival, donor to recipient matching may contribute to these outcomes.
在获取供体肝脏时，没有使用已故供体肝脏活检的标准。我们旨在评估肝脏活检及其对结局和移植物利用的影响。
从 2012 年 2 月至 2017 年 8 月（16 个 OPO）进行了一项对脑死亡供体的前瞻性观察性研究。通过 UNOS 供体管理目标登记册网络门户收集供体数据，并与 Scientific Registry of Transplant Recipients（SRTR）联系以获取受者结局。研究了接受活检供体肝脏（BxDL）的受者，并使用 Cox 比例风险分析确定了 1 年移植物存活率的独立预测因子。
对 5449 例肝移植受者的数据进行了分析，其中 1791 例（33%）接受了 BxDL。非 BxDL 和 BxDL 受者组之间的移植物或患者存活率无差异。在对 BxDL 受者的调整分析中，未发现宏观脂肪变性（21%-30%[n=148]和>30%[n=92]）预测 1 年移植物存活率，而供体年龄增加（HR1.02）、供体西班牙裔（HR1.62）、供体 INR（HR1.18）和受者生命支持（HR2.29）是。
BxDL 移植物受者可获得出色的移植物和患者存活率。值得注意的是，正如宏观脂肪变性对生存无影响所表明的那样，供体与受者匹配可能有助于实现这些结局。
