Victorian Liver Transplant Unit, Austin Health, Melbourne, Australia.
Department of Anesthesia, Austin Health, Melbourne, Australia.
Clin Transplant. 2021 Sep;35(9):e14419. doi: 10.1111/ctr.14419. Epub 2021 Sep 16.
Blood removed from organs during deceased donor organ procurement is routinely discarded but is a potential resource for donor-specific transfusion (DST) in subsequent liver transplantation (LT). This study retrospectively analyses the impact of DST on intraoperative bank blood product usage, long-term graft, and patient survival, as well as frequency of rejection post-LT.
A total of 992 adult LT performed from 1993 to 2018 in a single quaternary center were included. Intraoperative blood product usage, patient, and graft survival, as well as acute and chronic rejection were assessed in patients who received blood retrieved from the organ donor, the "donor blood" (DB) group (n = 437) and patients who did not, the "no donor blood" (NDB) group (n = 555).
Processing of DB ensured safe levels of potassium, magnesium, and insulin. There were fewer units of bank red blood cells transfusion required in the DB group compared to NDB group (2 vs. 4 units, P = .01). Graft survival was significantly superior in the DB group (10-year survival 75% vs. 69%, respectively, P = .04) but DST was not an independent predictor of graft survival. There was no significant difference in patient survival or rejection between the groups. There was no difference in treated, biopsy-proven rejection between the two groups.
This is the first large-cohort study assessing long-term outcomes of intraoperative DST in LT. The collection of organ donor blood and subsequent use in LT recipients appeared feasible with appropriate quality checks ensuring safety. DST resulted in a reduction in the use of packed red blood cells. There was no difference in the rate of rejection or graft or patient survival.
在进行已故供体器官获取时，从器官中取出的血液通常会被丢弃，但它是后续肝移植（LT）中供体特异性输血（DST）的潜在资源。本研究回顾性分析了 DST 对术中血库血液制品使用、长期移植物和患者存活率的影响，以及 LT 后排斥反应的频率。
纳入了 1993 年至 2018 年在一个四级中心进行的 992 例成人 LT。评估了接受从器官供体获取的血液（“供体血液”（DB）组，n=437）和未接受供体血液的患者（“无供体血液”（NDB）组，n=555）的患者术中血液制品使用、患者和移植物存活率，以及急性和慢性排斥反应。
DB 的处理确保了钾、镁和胰岛素的安全水平。与 NDB 组相比，DB 组需要输注的单位数更少（2 与 4 单位，P=0.01）。DB 组的移植物存活率显著更高（10 年存活率分别为 75%和 69%，P=0.04），但 DST 不是移植物存活率的独立预测因素。两组患者存活率或排斥反应无显著差异。两组间经治疗、活检证实的排斥反应无差异。
这是第一项评估 LT 中术中 DST 长期结果的大型队列研究。从器官供体中采集血液并随后用于 LT 受者似乎是可行的，只要进行适当的质量检查以确保安全性。DST 可减少浓缩红细胞的使用。排斥反应、移植物或患者存活率无差异。
