Liver Paired Exchange Using Compatible Pairs - US Single Center Experience.
Liver Paired Exchange Using Compatible Pairs - US Single Center Experience.
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使用兼容配对的肝脏配对交换 - 美国单中心经验。
DOI：
10.1097/sla.0000000000004122
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发表时间：
2020
影响因子：
9
通讯作者：
F. Cigarroa
中科院分区：
文献类型：
--
作者：
T. Klair;G. Halff;D. Fritze;Elizabeth Thomas;G. Abrahamian;K. Speeg;F. Cigarroa
B根据器官采购和移植网络（OPTN）的数据，2018年约有2500名候选人因死亡或病情恶化而从肝脏等待名单中删除。活体肝移植（LDLT）具有缓解器官短缺的潜力。成人间活体肝移植队列研究明确证明，LDLT受体的等待死亡率和移植物寿命显著降低。健康、有动机的献血者有时会因为血型不相容或解剖学原因而被拒绝。交换不相容的供体以产生称为肝脏配对交换（LPE）的相容性，有可能增加肝移植的获得。之前的LPE报告来自亚洲中心，主要用于克服血型不相容性。美国中心不存在LPE，也没有发布报告。这可能是由于美国中心的供体库较小，导致缺乏交换机会，并且不相容的O型供体相对短缺。LPE还提出了需要解决的道德，物流和财务问题。我们报告2例LPE在我们的中心进行。据我们所知，这是美国首次描述LPE，也是首次描述使用兼容对（CP）启动LPE。
B ased on organ procurement and transplantation network (OPTN) data, approximately 2500 candidates were removed from the liver waitlist due to death or worsening illness in 2018. Living donor liver transplantation (LDLT) has the potential to alleviate organ shortage. For recipients of LDLT a significant reduction in waitlist mortality and durable graft life was unequivocally demonstrated by the adult-to-adult living donor liver transplantation cohort study. Healthy, motivated donors are sometimes rejected for blood type incompatibility or anatomical reasons. Exchange of incompatible donors to create compatibility termed liver paired exchange (LPE) has the potential to increase access to liver transplantation. Prior reports of LPE come from Asian centers where it has been used predominantly to overcome blood type incompatibility. LPE is nonexistent in US centers with no published reports. This is likely due to smaller donor pools in US centers leading to lack of opportunities for exchange and relative shortage of blood type O donors in incompatible pairs. LPE also presents ethical, logistic and financial issues that need to be addressed. We report 2 cases of LPE performed at our center. To our knowledge this is the first description of LPE in the US and the first to describe use of compatible pairs (CP) to initiate LPE.