Muñoz Daniel Cabañó, Pérez Belinda Sánchez, Martínez María Pitarch, León Díaz Francisco Javier, Fernández Aguilar Jose Luis, Pérez Daga Jose Antonio, Santoyo Julio
Liver Transplant Unit, Department of Surgery, Regional University Hospital, Malaga, Spain.
Liver Transplant Unit, Department of Surgery, Regional University Hospital, Malaga, Spain.
Transplant Proc. 2020 Jun;52(5):1477-1480. doi: 10.1016/j.transproceed.2020.01.088. Epub 2020 Apr 3.
The so-called grafts or donors with extended criteria are a risk factor for the development of liver transplant activity. One source comes from controlled donation after circulatory death (cDCD). The hypothesis was to verify the improvement in results by comparing DCD liver transplants performed with postmortem normothermic regional perfusion (NRP) vs super-rapid recovery (SRR), the current standard for cDCD. A prospective study comparing both techniques was carried out.
A total of 42 transplants were performed with cDCD, 22 of which were with SRR and 23 with NRP from April 2014 to September 2019.
Differences were found in early allograft dysfunction (68.1% in the SRR group vs 25% in the NRP group; P < .01) and biliary complications (22.7% vs 5%, respectively; P = .04). Differences were also found, although not statistically significant, in ischemic cholangiopathy (13.6% in the SRR group vs 5% in the NRP group; P = .09), and retransplant rate (9.1% vs 0%, respectively; P = .3).
With the use of NRP machines, results are similar to the standard donation with donors in brain death in terms of rate of early allograft dysfunction and survival of the patient and graft attempted, reducing the rate of ischemic cholangiopathy compared with SRR.
所谓的扩大标准供体是肝移植活动开展的一个风险因素。其中一个来源是心脏死亡后器官捐献（cDCD）。本研究的假设是，通过比较采用尸温正常的区域灌注（NRP）与超快速恢复（SRR，cDCD的现行标准）进行的DCD肝移植的结果，验证结果是否有所改善。开展了一项比较这两种技术的前瞻性研究。
2014年4月至2019年9月期间，共进行了42例cDCD肝移植，其中22例采用SRR，23例采用NRP。
在早期移植物功能障碍方面存在差异（SRR组为68.1%，NRP组为25%；P <.01），在胆系并发症方面也存在差异（分别为22.7%和5%；P = 0.04）。在缺血性胆管病方面也发现了差异，尽管无统计学意义（SRR组为13.6%，NRP组为5%；P = 0.09），再移植率方面同样存在差异（分别为9.1%和0%；P = 0.3）。
使用NRP设备，在早期移植物功能障碍发生率以及患者和移植肝的存活率方面，结果与脑死亡供体的标准捐献相似，与SRR相比，缺血性胆管病发生率降低。
