Boira Mar Achalandabaso, Ferreira Luis, Nair Shrijit, Stafford Anthony, Maguire Donal
From St Vincent's University Hospital, Dublin, Ireland.
Exp Clin Transplant. 2021 Sep;19(9):887-893. doi: 10.6002/ect.2021.0079. Epub 2021 Aug 10.
With the current increased incidence of cirrhosis, the demand for liver transplant continues to grow. Here, we performed a systematic review to assess the feasibility, safety, and long-term outcomes of reused liver grafts for expansion of the donor pool. Our search identified 19 studies, including 36 patients plus 1 patient from our own institution. Ten studies were single case reports, 4 were case series, 4 were letters to the editor, and 1 was a literature review and also included a case report. Our patient presented with intentional acetaminophen overdose, received a transplant from a brain dead donor, and was confirmed brain dead 12 days posttransplant. The second recipient, who had alcoholrelated liver disease cirrhosis, underwent orthotopic liver transplant with the reused liver and was discharged from the hospital after an uneventful postoperative course. Among the 19 studies, all donors had confirmed brain death and all transplants included the whole liver, except for 2 cases of auxiliary liver grafts (reduced liver transplant) and 1 case of extended right living-donor liver graft (donor and recipient being related sisters). Overall, among first recipients, the most frequent cause of liver disease was acetaminophen overdose followed by alcohol-related liver disease cirrhosis. There were 2 cases of retransplant. Among second recipients, hepatocellular carcinoma was the most frequent cause of liver disease followed by alcohol-related liver disease cirrhosis. We found that functional outcomes with these grafts were comparable to outcomes with grafts from conventional donors; in the absence of other contraindications, we suggest that, not only for liver transplant but for other organs, these reused grafts can be used for those awaiting transplantation. Because the ability to reuse grafts is an infrequent condition, it would be difficult to generally recommend this technique; however, on a case-by-case basis, this source could expand the donor pool.
随着目前肝硬化发病率的上升，肝移植的需求持续增长。在此，我们进行了一项系统综述，以评估重复使用肝脏移植物来扩大供体库的可行性、安全性和长期结局。我们的检索共纳入19项研究，包括36例患者以及来自我们自己机构的1例患者。10项研究为单病例报告，4项为病例系列研究，4项为致编辑信，1项为文献综述且其中还包含1例病例报告。我们的患者因故意过量服用对乙酰氨基酚就诊，接受了来自脑死亡供体的移植，且在移植后12天被确认为脑死亡。第二位接受者患有酒精性肝病肝硬化，接受了使用该重复使用肝脏的原位肝移植，术后过程平稳，随后出院。在这19项研究中，所有供体均确诊为脑死亡，且除2例辅助性肝移植（减体积肝移植）和1例扩大右半活体供肝移植（供体和受体为亲姐妹）外，所有移植均包含整个肝脏。总体而言，在首次接受者中，最常见的肝病病因是对乙酰氨基酚过量，其次是酒精性肝病肝硬化。有2例再次移植。在二次接受者中，肝细胞癌是最常见的肝病病因，其次是酒精性肝病肝硬化。我们发现这些移植物的功能结局与来自传统供体的移植物结局相当；在没有其他禁忌证的情况下，我们建议，不仅对于肝移植，对于其他器官移植，这些重复使用的移植物可用于等待移植的患者。由于移植物重复使用的情况并不常见，一般很难推荐这项技术；然而，在个案基础上，这种来源可以扩大供体库。
