From the Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
From the Transplant Center, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, United States.
Exp Clin Transplant. 2021 Jun;19(6):580-587. doi: 10.6002/ect.2020.0441. Epub 2021 Apr 29.
Although donor shortages have prompted increased use of livers from donors after circulatory death, data are limited on their outcomes in low-volume centers and their applicability in this setting.
We retrospectively reviewed liver transplants from donors after circulatory death performed at our low-volume center over a 7-year period and identified predictors of outcomes.
Between 2007 and 2014, of 196 liver transplants (mean 28/year), donations after circulatory death accounted for 31%. Patient/liver graft survival rates were similar in recipients of brain dead donor versus circulatory death donor allografts (P = .47 and P = .87 respectively): 88.4% versus 85.7%/87.7 versus 86.3% at 1 year, 78.5 versus 74.2%/76.5% versus 75.4% at 3 years, and 70.8% versus 62.0%/65.1% versus 63.7% at 5 years. Multivariable analysis identified recipients with hepatitis C virus from donors >50 years old as an independent predictor of graft and patient survival (P < .01). Biliary complications trended higher in recipients of circulatory death donor livers. Among solitary liver transplant recipients, although biliary complications adversely affected graft survival in both groups (circulatory death vs brain dead donor cohorts, P = .02 vs P = .03), patient survival was only affected in the circulatory death donor cohort (P = .01). However, when all transplants were included in graft loss modeling, presence of biliary complications significantly impacted graft survival only in recipients of livers from circulatory death donors (P < .01). Among biliary complications, ischemic cholangiopathy had the greatest impact on graft loss (P ≤ .01).
Donation after circulatory death allografts could be safely used to expand the donor pool even in low-volume liver transplant centers. Outcomes were comparable to grafts from donors after brain death, although biliary complications, mainly because of ischemic cholangiopathy, had a greater effect on liver transplants from circulatory death donors. Efforts to minimize ischemic cholangiopathy could enable their greater utilization, regardless of center volume, without compromising outcomes.
尽管供体短缺促使更多使用循环死亡供体的肝脏，但关于低容量中心的结局数据有限，且其在该环境下的适用性也有限。
我们回顾性分析了 7 年间在我们低容量中心进行的循环死亡供体肝移植，并确定了结局的预测因素。
在 2007 年至 2014 年期间，196 例肝移植中（平均每年 28 例），有 31%来自循环死亡供体。脑死亡供体与循环死亡供体移植物受者的患者/肝移植物存活率相似（P=0.47 和 P=0.87）：1 年时分别为 88.4%和 85.7%/87.7%和 86.3%，3 年时分别为 78.5%和 74.2%/76.5%和 75.4%，5 年时分别为 70.8%和 62.0%/65.1%和 63.7%。多变量分析确定，来自>50 岁供体的丙型肝炎病毒受者是移植物和患者存活率的独立预测因素（P<0.01）。循环死亡供体肝脏受者的胆道并发症呈上升趋势。在单独进行肝移植的受者中，尽管胆道并发症对两组的移植物存活率都有不利影响（循环死亡供体组与脑死亡供体组，P=0.02 和 P=0.03），但只有循环死亡供体组的患者存活率受到影响（P=0.01）。然而，当所有移植都纳入移植物丢失模型时，胆道并发症的存在仅对循环死亡供体肝移植受者的移植物存活率有显著影响（P<0.01）。在胆道并发症中，缺血性胆管病对移植物丢失的影响最大（P≤0.01）。
即使在低容量的肝移植中心，循环死亡供体的同种异体移植物也可以安全地用于扩大供体库。结果与脑死亡供体的移植物相似，尽管胆道并发症（主要是由于缺血性胆管病）对循环死亡供体肝移植的影响更大。努力减少缺血性胆管病可以增加其利用率，而不会影响结果，无论中心容量如何。
