是否应该更多地利用循环死亡供体儿童捐献的肝脏移植物？2002 年至 2017 年 SRTR 的全国分析。

Should We Be Utilizing More Liver Grafts From Pediatric Donation After Circulatory Death Donors? A National Analysis of the SRTR from 2002 to 2017.

机构信息

Cleveland Clinic Lerner College of Medicine and Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.

Department of Surgery, Duke University Hospital, Durham, NC.

出版信息

Transplantation. 2021 Sep 1;105(9):1998-2006. doi: 10.1097/TP.0000000000003458.

DOI:10.1097/TP.0000000000003458

PMID:32947583

Abstract

BACKGROUND

Rates of withdrawal of life-sustaining treatment are higher among critically ill pediatric patients compared to adults. Therefore, livers from pediatric donation after circulatory death (pDCD) could improve graft organ shortage and waiting time for listed patients. As knowledge on the utilization of pDCD is limited, this study used US national registry data (2002-2017) to estimate the prognostic impact of pDCD in both adult and pediatric liver transplant (LT).

METHODS

In adult LT, the short-term (1-year) and long-term (overall) graft survival (GS) between pDCD and adult donation after circulatory death (aDCD) grafts was compared. In pediatric LT, the short- and long-term prognostic outcomes of pDCD were compared with other type of grafts (brain dead, split, and living donor).

RESULTS

Of 80 843 LTs in the study, 8967 (11.1%) were from pediatric donors. Among these, only 443 were pDCD, which were utilized mainly in adult recipients (91.9%). In adult recipients, short- and long-term GS did not differ significantly between pDCD and aDCD grafts (hazard ratio = 0.82 in short term and 0.73 in long term, both P > 0.05, respectively). Even "very young" (≤12 y) pDCD grafts had similar GS to aDCD grafts, although the rate of graft loss from vascular complications was higher in the former (14.0% versus 3.6%, P < 0.01). In pediatric recipients, pDCD grafts showed similar GS with other graft types whereas waiting time for DCD livers was significantly shorter (36.5 d versus 53.0 d, P < 0.01).

CONCLUSIONS

Given the comparable survival seen to aDCDs, this data show that there is still much scope to improve the utilization of pDCD liver grafts.

摘要

背景

与成人相比，重症儿科患者停止维持生命治疗的比例更高。因此，来自儿科脑死亡后捐献（pDCD）的肝脏可以改善供体器官短缺和等待名单上患者的时间。由于对 pDCD 的利用知识有限，本研究使用美国国家登记数据（2002-2017 年）来估计 pDCD 在成人和儿科肝移植（LT）中的预后影响。

方法

在成人 LT 中，比较了 pDCD 和成人循环死亡后捐献（aDCD）供体的短期（1 年）和长期（整体）移植物存活率（GS）。在儿科 LT 中，将 pDCD 的短期和长期预后结果与其他类型的移植物（脑死亡、劈裂和活体供体）进行比较。

结果

在研究的 80843 例 LT 中，8967 例（11.1%）来自儿科供体。其中，只有 443 例是 pDCD，主要用于成人受者（91.9%）。在成人受者中，pDCD 和 aDCD 移植物的短期和长期 GS 无显著差异（短期风险比=0.82，长期风险比=0.73，均 P > 0.05）。即使是“非常年轻”（≤12 岁）的 pDCD 移植物也具有与 aDCD 移植物相似的 GS，但前者血管并发症所致移植物丢失率较高（14.0%对 3.6%，P < 0.01）。在儿科受者中，pDCD 移植物的 GS 与其他移植物类型相似，而 DCD 肝脏的等待时间明显缩短（36.5 d 对 53.0 d，P < 0.01）。