AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Villejuif, France.
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Clin Transplant. 2021 Jan;35(1):e14046. doi: 10.1111/ctr.14046. Epub 2020 Dec 4.
In France, liver grafts which have been refused by at least five centers are proposed as rescue allocation (RA). The aim of this study is to clarify the feasibility and safety of RA grafts in liver transplantation (LT). Short- and long-term outcomes of patients who received RA grafts (RA group) were compared with those of patients who received standard allocation (SA) grafts (SA group). From a total of 1635 patients, 102 patients received RA grafts. Before matching, the RA group was characterized primarily by less severe liver disease, but the quality of graft was worse. After matching recipients' characteristics of 102 patients who used RA grafts with 306 patients who used SA grafts, recipients' characteristics were well balanced (1:3 matching). Although the rate of primary dysfunction was significantly higher in the RA group, there is no significant difference in the occurrence of major complications, length of hospitalization, and mortality between two groups. Graft survival (GS) and overall survival (OS) in the RA group were not significantly different from the SA group (GS; HR = 1.03 P = .89, OS; HR = 1.03 P = .90). In the French allocation system, the feasibility and safety of RA grafts might be comparable to SA grafts for carefully selected patients.
在法国，至少有五个中心拒绝的肝脏移植物被提议作为挽救性分配（RA）。本研究旨在阐明肝移植（LT）中 RA 移植物的可行性和安全性。比较了接受 RA 移植物（RA 组）的患者与接受标准分配（SA）移植物（SA 组）的患者的短期和长期结局。在总共 1635 名患者中，有 102 名患者接受了 RA 移植物。在匹配之前，RA 组主要表现为肝脏疾病较轻，但移植物质量较差。在匹配使用 RA 移植物的 102 名患者和使用 SA 移植物的 306 名患者的受体特征后，受体特征得到了很好的平衡（1:3 匹配）。尽管 RA 组原发性功能障碍的发生率显著较高，但两组之间主要并发症、住院时间和死亡率无显著差异。RA 组的移植物存活率（GS）和总存活率（OS）与 SA 组无显著差异（GS；HR=1.03，P=0.89，OS；HR=1.03，P=0.90）。在法国分配系统中，对于经过精心选择的患者，RA 移植物的可行性和安全性可能与 SA 移植物相当。
