Haque Omar J, Roth Eve M, Fleishman Aaron, Eckhoff Devin E, Khwaja Khalid
Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Ann Transplant. 2021 Apr 20;26:e930243. doi: 10.12659/AOT.930243.
BACKGROUND Donation after circulatory death (DCD) livers remain an underutilized pool of transplantable organs due to concerns of inferior long-term patient survival (PS) and graft survival (GS), which factors greatly into clinician decision-making and patient expectations. MATERIAL AND METHODS This retrospective study used SRTR data to assess 33 429 deceased-donor liver transplants (LT) and compared outcomes between DCD and donation after brain death (DBD) LT recipients in the United States. Data were collected from 2002 to 2008 to obtain 10 years of follow-up (2012-2018) in the era of MELD implementation. Propensity scores for donor type (DCD vs DBD) were estimated using logistic regression, and the association of donor type with 10-year outcomes was evaluated after adjustment using stabilized inverse probability of treatment weights. RESULTS After adjusting for confounders, patient survival for DBD recipients at 10 years was 60.7% versus 57.5% for DCD recipients (P=0.24). Incorporating retransplants, 10-year adjusted patient survival was 60.2% for DBD recipients versus 55.5% for DCD recipients (P=0.07). Adjusted 10-year graft survival for DBD recipients was 56.4% versus 45.4% for DCD recipients (P<0.001). Surprisingly, however, 1 year after LT, DBD and DCD graft failure rates converged to 7.5% over the remaining 9 years. CONCLUSIONS These data reveal inferior 10-year DCD graft survival, but only in the first year after LT, and similar 10-year patient survival in DCD LT recipients compared to DBD recipients. Our results show the stability and longevity of DCD grafts, which should encourage the increased utilization of these livers for transplantation.
背景 由于担心循环死亡后捐赠（DCD）肝脏移植的患者长期生存率（PS）和移植物生存率（GS）较低，这一可移植器官来源的利用率仍然不高，而这些因素在很大程度上影响了临床医生的决策和患者的期望。材料与方法 这项回顾性研究使用器官获取与移植网络（SRTR）的数据评估了33429例已故供体肝移植（LT），并比较了美国DCD肝移植受者和脑死亡后捐赠（DBD）肝移植受者的结局。收集2年至2008年的数据，以在终末期肝病模型（MELD）实施时代获得10年的随访期（2012年至2018年）。使用逻辑回归估计供体类型（DCD与DBD）的倾向得分，并在使用稳定的治疗权重逆概率进行调整后，评估供体类型与10年结局的关联。结果 在调整混杂因素后，DBD受者10年的患者生存率为60.7%，而DCD受者为57.5%（P=0.24）。纳入再次移植后，DBD受者10年调整后的患者生存率为60.2%，而DCD受者为55.5%（P=0.07）。DBD受者调整后的10年移植物生存率为56.4%，而DCD受者为45.4%（P<0.001）。然而，令人惊讶的是，肝移植后1年，DBD和DCD移植物失败率在接下来的9年中趋于一致，均为7.5%。结论 这些数据显示DCD移植物10年生存率较低，但仅在肝移植后的第一年，且DCD肝移植受者与DBD受者的10年患者生存率相似。我们的结果显示了DCD移植物的稳定性和长期存活情况，这应鼓励增加对这些肝脏进行移植的利用率。
