Department of Gastroenterology & Hepatology, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Am J Transplant. 2021 Jan;21(1):382-390. doi: 10.1111/ajt.16286. Epub 2020 Oct 8.
Limited data exist regarding the impact of donation after circulatory death (DCD) allografts on outcomes following liver transplantation in fulminant hepatic failure (FHF). Utilizing the Scientific Registry of Transplant Recipients (SRTR), we compared outcomes after DCD in FHF to donation after brain death (DBD) in FHF and DCD in non-FHF over a 15-year period. Primary outcome measures were graft and patient survival. A total of 117, 3437, and 4379 recipients underwent DCD-FHF, DBD-FHF and DCD-non-FHF, respectively. One-year graft survival in DCD-FHF was inferior to DBD-FHF (72.9% vs. 83.8%, p = .002), but comparable to DCD-non-FHF (72.9% vs. 82.7%, p = .23). However, 3- and 5-year graft survival in DCD-FHF were comparable to DBD-FHF (67.9 vs. 77.6%, p = .63; 57.8% vs. 73.2%, p = .27) and DCD-non-FHF (67.9% vs. 72.9%, p = .44; 57.8% vs. 66.6%, p = .06). One-, 3-, and 5-year patient survival were also comparable among the three groups. Graft and patient survival in DCD-FHF improved over the study period. Multivariable analysis identified recipient age, male gender, African American ethnicity, donor age, and cold ischemia time as predictors of graft and patient survival in FHF, while DCD status was only predictive of graft survival. Long-term graft survival and patient survival in DCD-FHF are comparable to DBD-FHF and DCD-non-FHF. Consideration of DCD in FHF could help expand the donor pool in this subset of critically ill patients.
关于在暴发性肝衰竭 (FHF) 中进行死后循环死亡 (DCD) 同种异体移植对肝移植后结果的影响，相关数据有限。本研究利用移植受者科学登记处 (SRTR)，比较了 15 年来 FHF 中的 DCD 与 FHF 中的脑死亡供体 (DBD) 和非 FHF 中的 DCD 的结果。主要结果测量为移植物和患者存活率。分别有 117、3437 和 4379 例患者接受了 DCD-FHF、DBD-FHF 和 DCD-非 FHF。DCD-FHF 的 1 年移植物存活率低于 DBD-FHF（72.9%比 83.8%，p=0.002），但与 DCD-非 FHF 相似（72.9%比 82.7%，p=0.23）。然而，DCD-FHF 的 3 年和 5 年移植物存活率与 DBD-FHF（67.9 比 77.6%，p=0.63；57.8 比 73.2%，p=0.27）和 DCD-非 FHF（67.9%比 72.9%，p=0.44；57.8%比 66.6%，p=0.06）相似。三组患者的 1 年、3 年和 5 年存活率也相似。在研究期间，DCD-FHF 的移植物和患者存活率均有所提高。多变量分析确定了受体年龄、男性、非裔美国人种族、供体年龄和冷缺血时间是 FHF 中移植物和患者存活率的预测因素，而 DCD 状态仅与移植物存活率相关。DCD-FHF 的长期移植物和患者存活率与 DBD-FHF 和 DCD-非 FHF 相似。在 FHF 中考虑 DCD 可能有助于扩大这组危重病患者的供体库。
