From the Division of Transplant Surgery, Department of General Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.
Exp Clin Transplant. 2021 Jun;19(6):563-569. doi: 10.6002/ect.2020.0387. Epub 2021 May 6.
The use of deceased after circulatory death liver allografts in patients with primary sclerosing cholangitis is controversial, given the increased risk of graft complications in patients with primary sclerosing cholangitis. We hypothesized that transplant of deceased after circulatory death livers into recipients with primary sclerosing cholangitis when appropriately selected using the UK deceased after circulatory death scoring system is not associated with increased graft failure and mortality.
We analyzed 99 229 transplants (between January 2001 and December 2018) from the Organ Procurement and Transplantation Network database. Deceased after circulatory death transplants were stratified by the UK scoring system as low risk or high risk. We identified 3958 patients with primary sclerosing cholangitis who received deceased after brain death transplant and 95 patients with primary sclerosing cholangitis who received deceased after circulatory death transplant.
As expected, 5-year graft survival was lower in the circulatory death recipient group (69.0% vs 78.4%; P = .02). However, 5-year graft survival was significantly lower in the high-risk versus low-risk UK scoring system group (60.0% vs 75.4%; P = .02), with rate in the low-risk group similar to the brain death recipient group (78.4% vs 75.4%; P = .52). On multivariate analysis, the high-risk group had significantly increased risk of graft loss (hazard ratio of 1.92; P = .01). However, the low-risk group had equivalent graft survival to the brain death recipient group (hazard ratio of 1.23; P = .31).
Graft failure was higher in patients with primary sclerosing cholangitis who received livers from deceased after circulatory death donors; however, the risk of graft loss was abrogated using appropriately matched donor and recipient combinations.
由于原发性硬化性胆管炎患者的移植物并发症风险增加，因此使用死后循环死亡供体的肝脏进行同种异体移植存在争议。我们假设，使用英国死后循环死亡评分系统适当选择原发性硬化性胆管炎患者的死后循环死亡供体肝脏进行移植，与移植物失功和死亡率增加无关。
我们分析了器官获取与移植网络数据库中 99229 例（2001 年 1 月至 2018 年 12 月）移植病例。根据英国评分系统，死后循环死亡移植分为低危和高危。我们确定了 3958 例接受死后脑死亡移植的原发性硬化性胆管炎患者和 95 例接受死后循环死亡移植的原发性硬化性胆管炎患者。
正如预期的那样，循环死亡受者组的 5 年移植物存活率较低（69.0%比 78.4%；P=0.02）。然而，高危与低危英国评分系统组的 5 年移植物存活率有显著差异（60.0%比 75.4%；P=0.02），低危组的存活率与脑死亡受者组相似（78.4%比 75.4%；P=0.52）。多变量分析显示，高危组移植物丢失风险显著增加（风险比为 1.92；P=0.01）。然而，低危组的移植物存活率与脑死亡受者组相当（风险比为 1.23；P=0.31）。
原发性硬化性胆管炎患者接受死后循环死亡供者的肝脏后，移植物失功的风险更高；然而，通过适当匹配供体和受者组合，可以降低移植物丢失的风险。
