Goff Cameron, Zhang Theodore, McDonald Malcolm, Anand Adrish, Galvan Nhu Thao Nguyen, Kanwal Fasiha, Cholankeril George, Hernaez Ruben, Goss John A, Rana Abbas
Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA.
Division of Abdominal Transplantation, Michael E DeBakey Department of General Surgery, Baylor College of Medicine, Houston, Texas, USA.
Clin Transplant. 2022 Mar;36(3):e14544. doi: 10.1111/ctr.14544. Epub 2021 Dec 13.
The study of marginal liver transplant outcomes, including post-transplant length of stay (LOS), is necessary for determining the practicality of their use. 50 155 patients who received transplants from 2012 to 2020 were retrospectively analyzed with data from the Scientific Registry of Transplant Recipients database using Kaplan-Meier survival curves and multivariable Cox regression. Six different definitions were used to classify an allograft as being marginal: 90 percentile Donor Risk Index (DRI) allografts, donation after cardiac death (DCD) donors, national share donors, donors over 70, donors with > 30% macrovesicular steatosis, or 90 percentile Discard Risk Index donors. 24% (n = 12 124) of subjects received marginal allografts. Average LOS was 15.6 days among those who received standard allografts. Among those who received marginal allografts, LOS was found to be highest in those who received 90 percentile DRI allografts at 15.6 days, and lowest in those who received DCD allografts at 12.7 days. Apart from fatty livers (95% CI .86-.98), marginal allografts were not associated with a prolonged LOS. We conclude that accounting for experience and recipient matching, transplant centers may be more aggressive in their use of extended criteria donors with limited fear of increasing LOS and its associated costs.
研究边缘性肝移植的结果，包括移植后的住院时间（LOS），对于确定其应用的实用性很有必要。利用移植受者科学注册数据库的数据，采用Kaplan-Meier生存曲线和多变量Cox回归，对2012年至2020年接受移植的50155例患者进行了回顾性分析。采用六种不同的定义将同种异体移植物分类为边缘性：第90百分位供体风险指数（DRI）的同种异体移植物、心脏死亡后捐赠（DCD）供体、全国共享供体、70岁以上供体、大泡性脂肪变性>30%的供体或第90百分位丢弃风险指数供体。24%（n = 12124）的受试者接受了边缘性同种异体移植物。接受标准同种异体移植物的患者平均住院时间为15.6天。在接受边缘性同种异体移植物的患者中，接受第90百分位DRI同种异体移植物的患者住院时间最长，为15.6天，而接受DCD同种异体移植物的患者住院时间最短，为12.7天。除脂肪肝外（95%CI.86-.98），边缘性同种异体移植物与住院时间延长无关。我们得出结论，考虑到经验和受者匹配情况，移植中心在使用扩展标准供体时可能会更积极，而不必过于担心住院时间及其相关成本的增加。
