Ischemic Cholangiopathy Postdonation After Circulatory Death Liver Transplantation: Donor Hepatectomy Time Matters.
Ischemic Cholangiopathy Postdonation After Circulatory Death Liver Transplantation: Donor Hepatectomy Time Matters.
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DOI：
10.1097/txd.0000000000001277
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发表时间：
2022-01
影响因子：
2.3
通讯作者：
LaMattina JC
中科院分区：
文献类型：
--
作者：
Goussous N;Alvarez-Casas J;Dawany N;Xie W;Malik S;Gray SH;Barth RN;LaMattina JC
循环性死亡(DCD)后捐献的肝移植(LT)的结果已经有所改善；然而，缺血性胆管病(IC)仍然是一个问题。2014年，为改善供体肝移植的效果，已采取措施最大限度地缩短供肝切除时间(DHT)和冷缺血时间(CIT)。对2005-2017年间接受DCD肝移植的所有患者进行了回顾性研究。我们比较了2014年前移植的患者(历史组)和2014-2017年间移植的患者(现代组)的结果。我们确定了112名患者，其中44人属于历史组，68人属于现代组。历史献血者年龄较小(26.5vs33，P=0.007)，体重指数较低(26.2vs28.2，P=0.007)。历史组的dht(Min)和Cit(H)显著延长(分别为21.5vs14，P<；0.001和5.3vs4.2，P<；0.001)。14例患者(12.5%)发生IC，其中有病史的患者发生率(23.3%)显著高于既往组(6.1%，P=0.02)。两组患者的移植物存活率和患者存活率没有差异。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。这些变化可能会扩大DCD捐赠者的范围。
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, P = 0.007) and had a lower body mass index (26.2 versus 28.2, P = 0.007). DHT (min) and CIT (h) were significantly longer in the historic group (21.5 versus 14, P < 0.001 and 5.3 versus 4.2, P < 0.001, respectively). Fourteen patients (12.5%) developed IC, with a significantly higher incidence in the historic group (23.3% versus 6.1%, P = 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.