Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
Department of Transplant, Mayo Clinic Florida, Jacksonville, FL.
Transplantation. 2021 Jun 1;105(6):1156-1164. doi: 10.1097/TP.0000000000003819.
Donation after circulatory death (DCD) grafts are commonly used in liver transplantation. Attributable to the additional ischemic event during the donor warm ischemia time (DWIT), DCD grafts carry an increased risk for severe ischemia/reperfusion injury and postoperative complications, such as ischemic cholangiopathy. The actual ischemia during DWIT depends on the course of vital parameters after withdrawal of life support and varies widely between donors. The ischemic period (functional DWIT) starts when either Spo2 or blood pressure drop below a certain point and lasts until the start of cold perfusion during organ retrieval. Over the years, multiple definitions and thresholds of functional DWIT duration have been used. The International Liver Transplantation Society organized a Consensus Conference on DCD, Liver Preservation, and Machine Perfusion on January 31, 2020 in Venice, Italy. The aim of this conference was to reach consensus about various aspects of DCD liver transplantation in context of currently available evidence. Here we present the recommendations with regards to the definitions used for DWIT and functional DWIT, the importance of vital parameters after withdrawal of life support, and acceptable thresholds of duration of functional DWIT to proceed with liver transplantation.
在肝移植中，经常使用循环死亡后捐献（DCD）供体的移植物。由于供体热缺血时间（DWIT）期间发生了额外的缺血事件，DCD 移植物发生严重缺血/再灌注损伤和术后并发症（如缺血性胆管病）的风险增加。DWIT 期间的实际缺血程度取决于停止生命支持后生命体征的变化过程，并且在供体之间差异很大。缺血期（功能性 DWIT）从 SpO2 或血压降至某一水平以下开始，持续到器官获取期间冷灌注开始时为止。多年来，已经使用了多种功能性 DWIT 持续时间的定义和阈值。国际肝脏移植学会于 2020 年 1 月 31 日在意大利威尼斯组织了一次关于 DCD、肝脏保存和机器灌注的共识会议。本次会议的目的是就目前可用证据的 DCD 肝移植的各个方面达成共识。在这里，我们提出了关于 DWIT 和功能性 DWIT 使用的定义、停止生命支持后生命体征的重要性以及进行肝移植可接受的功能性 DWIT 持续时间阈值的建议。
