尽管对肝脏利用率有影响，但同期胸腹联合心脏死亡后器官捐献（DCD）器官获取后2年肝脏移植结局良好。
Preserved 2-y Liver Transplant Outcomes Following Simultaneous Thoracoabdominal DCD Organ Procurement Despite Effects on Liver Utilization Rate.
作者信息
Wisel Steven A, Steggerda Justin A, Thiessen Carrie, Roll Garrett R, Chen Qiudong, Thomas Jason, Kaur Bhupinder, Catarino Pedro, Chikwe Joanna, Kim Irene K
机构信息
Department of Surgery, Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA.
Division of Transplant Surgery, University of Wisconsin, Madison, WI.
出版信息
Transplant Direct. 2023 Oct 20;9(11):e1528. doi: 10.1097/TXD.0000000000001528. eCollection 2023 Nov.
BACKGROUND
Current techniques for donation after circulatory determination of death (DCD) heart procurement, through either direct procurement and machine perfusion or thoracoabdominal normothermic regional perfusion (NRP), have demonstrated excellent heart transplant outcomes. However, the impact of thoracoabdominal DCD (TA-DCD) heart procurement on liver allograft outcomes and utilization is poorly understood.
METHODS
One hundred sixty simultaneous heart and liver DCD donors were identified using the United Network for Organ Sharing/Organ Procurement and Transplantation Network database between December 2019 and July 2021. Liver outcomes from TA-DCD donors were stratified by heart procurement technique and evaluated for organ utilization, graft survival, and patient survival. Results were compared with abdominal-only DCD (A-DCD; n = 1332) and donation after brain death (DBD; n = 12 891) liver transplants during the study interval. Kaplan-Meier methods with log-rank testing were used to evaluate patient and graft survival.
RESULTS
One hundred thirty-three of 160 livers procured from TA-DCD donors proceeded to transplant. TA-DCD donors were younger (mean 28.26 y; < 0.0001) with lower body mass index (mean 26.61; < 0.0001) than A-DCD and DBD donors. TA-DCD livers had equivalent patient survival ( = 0.893) and superior graft survival ( = 0.009) compared with A-DCD. TA-DCD livers had higher rates of organ discard for long warm ischemia time (37.0%) than A-DCD (20.5%) and DBD (0.5%; < 0.0001), with direct procurement and machine perfusion procurements leading to a higher discard rate (18.5%) than NRP procurements (7.4%).
CONCLUSIONS
Liver transplants after TA-DCD donation demonstrated equivalent patient outcomes and excellent graft outcomes. NRP procurements resulted in the lowest rate of organ discard after DCD donation and may represent an optimal strategy to maximize organ utilization.
背景
目前用于心脏获取的循环判定死亡后捐赠（DCD）技术，无论是直接获取和机器灌注还是胸腹常温区域灌注（NRP），都已证明心脏移植效果出色。然而，胸腹DCD（TA-DCD）心脏获取对肝移植效果和利用率的影响却知之甚少。
方法
利用器官共享联合网络/器官获取与移植网络数据库，在2019年12月至2021年7月期间识别出160例同时进行心脏和肝脏DCD捐赠者。TA-DCD捐赠者的肝脏结果按心脏获取技术分层，并对器官利用率、移植物存活和患者存活情况进行评估。将结果与同期仅腹部DCD（A-DCD；n = 1332）和脑死亡后捐赠（DBD；n = 12891）的肝移植进行比较。采用Kaplan-Meier方法和对数秩检验来评估患者和移植物存活情况。
结果
从TA-DCD捐赠者获取的160例肝脏中有133例进行了移植。TA-DCD捐赠者比A-DCD和DBD捐赠者更年轻（平均28.26岁；<0.0001），体重指数更低（平均26.61；<0.0001）。与A-DCD相比，TA-DCD肝脏的患者存活率相当（=0.893），移植物存活率更高（=0.009）。TA-DCD肝脏因长热缺血时间导致的器官丢弃率（37.0%）高于A-DCD（20.5%）和DBD（0.5%；<0.0001），直接获取和机器灌注获取导致的丢弃率较高（18.5%），高于NRP获取（7.4%）。
结论
TA-DCD捐赠后的肝移植显示出相当的患者结果和出色的移植物结果。NRP获取导致DCD捐赠后器官丢弃率最低，可能是使器官利用率最大化的最佳策略。
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