Pagano Duilio, Barbàra Marco, Seidita Aurelio, Cintorino Davide, di Francesco Fabrizio, Petridis Ioannis, Calamia Sergio, Russelli Giovanna, Gruttadauria Salvatore
Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico - Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy.
Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico - Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy; Department of Surgery and Surgical and Medical Specialties, University of Catania, Catania, Italy.
Transplant Proc. 2020 Jun;52(5):1588-1592. doi: 10.1016/j.transproceed.2020.02.050. Epub 2020 Mar 26.
The adoption of extended criteria for donors remains the best strategy to widen the pool of available liver graft against the chronic shortage of donors. Benchmarking in liver transplantation (LT) offers the unprecedented opportunity to compare clinical outcome measures to a set of validated reference values. We aimed to evaluate the impact of marginal grafts usage in a cohort of low-risk benchmark cases from an area with a very low rate of deceased donation.
A cohort of low-risk benchmark cases was identified from all adult patients who underwent LT at our center. Among these patients, those transplanted with a graft from an extended-criteria donor (ECD) were identified. Benchmark metrics (length of hospital and intensive care unit stay, incidences of mortality, graft loss, and postoperative complication) were compared with benchmark cutoffs and between the 2 groups.
Two hundred forty-five patients satisfied the inclusion criteria, 146 (60%) of whom received an organ from an ECD. Overall, all benchmark metrics where within the cutoffs limits, except for graft loss (14% vs 11%) and mortality (10% vs 9% 1 year after LT). The ECD group was associated with more grade III complications (60% vs 45%, P = .031), graft loss (18% vs 8%, P = .038), and mortality (14% vs 4%, P = .009). Hepatocellular carcinoma diagnosis was found to be associated with less mortality (odds ratio = 0.42, P = .048).
While ECD graft usage is associated with slightly worse prognosis, our experience suggests that their use can be considered safe, especially when matched on hepatocellular carcinoma recipients.
采用扩大标准供体仍然是应对供体长期短缺、扩大可用肝移植供体库的最佳策略。肝移植的基准化提供了前所未有的机会，可将临床结局指标与一组经过验证的参考值进行比较。我们旨在评估在一个尸体捐赠率极低地区的低风险基准病例队列中使用边缘供肝的影响。
从在我们中心接受肝移植的所有成年患者中确定一个低风险基准病例队列。在这些患者中，识别出接受扩大标准供体（ECD）肝脏移植的患者。将基准指标（住院时间、重症监护病房停留时间、死亡率、移植物丢失率和术后并发症发生率）与基准临界值进行比较，并在两组之间进行比较。
245例患者符合纳入标准，其中146例（60%）接受了ECD供肝。总体而言，除移植物丢失率（14%对11%）和死亡率（肝移植后1年为10%对9%）外，所有基准指标均在临界值范围内。ECD组与更多的III级并发症（60%对45%，P = 0.031）、移植物丢失（18%对8%，P = 0.038）和死亡率（14%对4%，P = 0.009）相关。发现肝细胞癌诊断与较低的死亡率相关（比值比 = 0.42，P = 0.048）。
虽然使用ECD供肝与稍差的预后相关，但我们的经验表明，其使用可被认为是安全的，尤其是在与肝细胞癌受者匹配时。
