Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
Department of Anesthesiology, Perioperative and Pain Medicine, the Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
Clin Transplant. 2024 May;38(5):e15336. doi: 10.1111/ctr.15336.
Individual events during donation after circulatory death (DCD) procurement, such as hypotensive or hypoxic warm ischemia, or circulatory arrest are all a part of donor warm ischemia time (dWIT), and may have differing effects on the outcome of the liver graft. This study aimed to identify risk factors for postreperfusion syndrome (PRS), a state of severe hemodynamic derangement following graft reperfusion, and its impact on DCD liver transplantation (LT) outcomes.
This was a retrospective analysis using 106 DCD LT. Detailed information for events during procurement (withdrawal of life support; systolic blood pressure < 80 mmHg; oxygen saturation < 80%; circulatory arrest; aortic cold perfusion) and their association with the development of PRS were examined using logistic regression.
The overall incidence of PRS was 26.4%, occurring in 28 patients. Independent risk factors for PRS were asystolic dWIT (odds ratio (OR) 3.65, 95% confidence interval (CI) 1.38-9.66) and MELD score (OR 1.06, 95% CI 1.01-1.10). Total bilirubin was significantly higher in the PRS group at postoperative day (POD) 1 (p = .02; 5.2 mg/dL vs. 3.4 mg/dL), POD 3 (p = .049; 4.5 mg/dL vs. 2.8 mg/dL), and POD 7 (p = .04; 3.1 mg/dL vs. 1.9 mg/dL). Renal replacement therapy after LT was more likely to be required in the PRS group (p = .01; 48.2% vs. 23.1%).
Asystolic dWIT is a risk factor for the development of PRS in DCD LT. Our results suggest that asystolic dWIT should be considered when selecting DCD liver donors.
在心跳停止死亡后供体器官获取过程中的个体事件，如低血压或低氧性热缺血，或循环停止，都是供体热缺血时间（dWIT）的一部分，并且可能对肝移植物的结果产生不同的影响。本研究旨在确定再灌注后综合征（PRS）的危险因素，PRS 是移植物再灌注后严重血流动力学紊乱的状态，及其对 DCD 肝移植（LT）结果的影响。
本研究使用 106 例 DCD-LT 进行回顾性分析。使用逻辑回归检查获取过程中事件（停止生命支持；收缩压<80mmHg；氧饱和度<80%；循环停止；主动脉冷灌注）的详细信息及其与 PRS 发展的相关性。
PRS 的总发生率为 26.4%，发生在 28 例患者中。PRS 的独立危险因素是停搏性 dWIT（比值比（OR）3.65，95%置信区间（CI）1.38-9.66）和 MELD 评分（OR 1.06，95%CI 1.01-1.10）。PRS 组在术后第 1 天（p=0.02；5.2mg/dL 比 3.4mg/dL）、第 3 天（p=0.049；4.5mg/dL 比 2.8mg/dL）和第 7 天（p=0.04；3.1mg/dL 比 1.9mg/dL）的总胆红素明显更高。PRS 组在 LT 后更有可能需要肾脏替代治疗（p=0.01；48.2%比 23.1%）。
停搏性 dWIT 是 DCD-LT 中 PRS 发展的危险因素。我们的结果表明，在选择 DCD 肝供体时应考虑停搏性 dWIT。
