Division of Transplantation, Department of Surgery, University of Washington, Seattle, WA, USA.
Seattle Children's Hospital, Section of Pediatric Transplantation, Seattle, WA, USA.
Pediatr Transplant. 2020 Jun;24(4):e13712. doi: 10.1111/petr.13712. Epub 2020 Apr 22.
Many transplant programs are reluctant to use organs from deceased donors designated as "PHS increased risk" due to misconceptions regarding the quality of those organs. This study evaluated the impact of PHS increased risk donors on patient and allograft survival in pediatric patients undergoing liver transplantation. Retrospective analysis of the UNOS database from January 2005 through September 2017 revealed 5615 pediatric patients who underwent isolated liver transplantation; of these, 5057 patients received primary isolated liver transplants and 558 patients received isolated liver retransplants. PHS increased risk organs were used in 6.7% and 5.4% of the children receiving primary isolated and retransplant livers, respectively. Cox proportional hazards models adjusted for donor and recipient characteristics determined the relative risk of PHS status on allograft and patient survival. Sicker children (those in ICU [P < .001] and on life support [P = .04]) were more likely to receive PHS increased risk donor organs. There were no differences in overall patient (P = .61) or allograft (P = .68) survival between pediatric patients receiving PHS positive vs PHS negative deceased donor organs; adjusted models also demonstrated no statistically significant differences in patient or allograft survival. Excellent patient and allograft survival can be accomplished with PHS increased risk organs.
许多移植项目由于对这些器官质量的误解，不愿意使用被指定为“PHS 增加风险”的已故捐献者的器官。本研究评估了 PHS 增加风险供体对接受肝移植的儿科患者患者和移植物存活率的影响。对 2005 年 1 月至 2017 年 9 月 UNOS 数据库的回顾性分析显示，5615 名儿科患者接受了孤立性肝移植；其中 5057 名患者接受了原发性孤立性肝移植，558 名患者接受了孤立性肝再移植。在接受原发性孤立性和再移植肝脏的儿童中，分别有 6.7%和 5.4%使用了 PHS 增加风险器官。通过调整供体和受者特征的 Cox 比例风险模型，确定了 PHS 状态对移植物和患者存活率的相对风险。病情较重的儿童（在 ICU 中[P<.001]和接受生命支持[P=.04]）更有可能接受 PHS 增加风险供体器官。在接受 PHS 阳性和 PHS 阴性已故供体器官的儿科患者之间，总体患者（P=.61）或移植物（P=.68）存活率没有差异；调整后的模型也表明，患者或移植物存活率没有统计学上的显著差异。使用 PHS 增加风险器官可以实现出色的患者和移植物存活率。
