A Registry Analysis of Damage to the Deceased Donor Pancreas During Procurement
A Registry Analysis of Damage to the Deceased Donor Pancreas During Procurement
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DOI：
10.1111/ajt.13419
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发表时间：
2015-11-01
影响因子：
8.8
通讯作者：
Callaghan, C. J.
中科院分区：
文献类型：
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作者：
Ausania, F.;Drage, M.;Callaghan, C. J.
外科手术对胰腺的损伤被认为在采购过程中很常见。分析了英国移植注册中心，以确定胰腺损伤的频率，确定与损伤相关的因素，并评估损伤对移植物存活的影响。脑死亡后捐献胰腺1,296例，其中循环死亡供者314例(19.5%)。超过50%的恢复胰腺至少有一个损伤，最常见的是门静脉短路(21.5%)。单因素分析显示，捐献肝脏、采购团队来源、来自肠系膜上动脉(SMA)的肝动脉(HA)以及供者体重指数的增加与胰腺损伤率的增加相关；在多因素分析中，只有来自SMA的HA的存在仍然显著(p=0.02)。共进行了640例实体器官胰腺移植，其中238例存在某种形式的损伤。总体而言，受损和未受损器官之间的移植物存活率没有差异(p=0.28)；然而，移植物丢失在有动脉受损的胰腺(p=0.04)和有实质受损的胰腺(p=0.05)中明显更常见。在器官回收过程中，胰腺损伤比其他器官更常见，细致的手术技术和对损伤风险因素的认识对于降低采购相关损伤的发生率至关重要。
Surgical injury to the pancreas is thought to occur commonly during procurement. The UK Transplant Registry was analyzed to determine the frequency of pancreatic injuries, identify factors associated with damage, and assess the impact of injuries on graft survival. Twelve hundred ninety-six pancreata were procured from donation after brain death donors, with 314 (19.5%) from donation after circulatory death donors. More than 50% of recovered pancreata had at least one injury, most commonly a short portal vein (21.5%). Liver donation, procurement team origin, hepatic artery (HA) arising from the superior mesenteric artery (SMA), and increasing donor BMI were associated with increased rates of pancreas damage on univariate analyses; on multivariate analysis only the presence of an HA from the SMA remained significant (p=0.02). Six hundred forty solid organ pancreas transplants were performed; 238 had some form of damage. Overall, there was no difference in graft survival between damaged and undamaged organs (p=0.28); however, graft loss was significantly more frequent in pancreata with arterial damage (p=0.04) and in those with parenchymal damage (p=0.05). Damage to the pancreas during organ recovery is more common than other organs, and meticulous surgical technique and awareness of damage risk factors are essential to reduce rates of procurement-related injuries.