Goussous Naeem, Alvarez-Casas Josue, Dawany Noor, Xie Wen, Malik Saad, Gray Stephen H, Barth Rolf N, LaMattina John C
Division of Transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA.
Transplant Direct. 2021 Dec 23;8(1):e1277. doi: 10.1097/TXD.0000000000001277. eCollection 2022 Jan.
Outcomes of liver transplantation (LT) from donation after circulatory death (DCD) have been improving; however, ischemic cholangiopathy (IC) continues to be a problem. In 2014, measures to minimize donor hepatectomy time (DHT) and cold ischemic time (CIT) have been adopted to improve DCD LT outcomes.
Retrospective review of all patients who underwent DCD LT between 2005 and 2017 was performed. We compared outcomes of patients who were transplanted before 2014 (historic group) with those who were transplanted between 2014 and 2017 (modern group).
We identified 112 patients; 44 were in the historic group and 68 in the modern group. Donors in the historic group were younger (26.5 versus 33, = 0.007) and had a lower body mass index (26.2 versus 28.2, = 0.007). DHT (min) and CIT (h) were significantly longer in the historic group (21.5 versus 14, < 0.001 and 5.3 versus 4.2, < 0.001, respectively). Fourteen patients (12.5%) developed IC, with a significantly higher incidence in the historic group (23.3% versus 6.1%, = 0.02). There was no difference in graft and patient survival between both groups.
In appropriately selected recipients, minimization of DHT and CIT may decrease the incidence of IC. These changes can potentially expand the DCD donor pool.
循环死亡后器官捐献（DCD）肝移植的结果一直在改善；然而，缺血性胆管病（IC）仍然是一个问题。2014年，已采取措施尽量缩短供肝切除时间（DHT）和冷缺血时间（CIT），以改善DCD肝移植的结果。
对2005年至2017年间接受DCD肝移植的所有患者进行回顾性研究。我们比较了2014年前接受移植的患者（历史组）和2014年至2017年间接受移植的患者（现代组）的结果。
我们确定了112例患者；历史组44例，现代组68例。历史组的供者更年轻（26.5岁对33岁，P = 0.007），体重指数更低（26.2对28.2，P = 0.007）。历史组的DHT（分钟）和CIT（小时）明显更长（分别为21.5对14，P < 0.001和5.3对4.2，P < 0.001）。14例患者（12.5%）发生IC，历史组的发生率明显更高（23.3%对6.1%，P = 0.02）。两组之间的移植物和患者生存率没有差异。
在适当选择的受者中，尽量减少DHT和CIT可能会降低IC的发生率。这些改变可能会扩大DCD供者库。
