Ischemic cholangiopathy following liver transplantation from donation after cardiac death donors
Ischemic cholangiopathy following liver transplantation from donation after cardiac death donors
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DOI：
10.1002/lt.21361
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发表时间：
2008-05-01
影响因子：
4.6
通讯作者：
Levy, Adam E.
中科院分区：
文献类型：
--
作者：
Chan, Edie Y.;Olson, Les C.;Levy, Adam E.
心脏死亡后捐献（DCD）供者肝同种异体移植的使用越来越普遍;然而，已经有报道称，与这种类型的同种异体移植相关的特定并发症导致移植失败的增加。缺血性胆管病（IC）的并发症已被报道在使用DCD肝移植物后更频繁地发生。我们报告了52例DCD供者肝移植的结果和影响IC发生的因素。我们对2003年9月至2006年12月在一家机构进行的所有DCD和脑死亡（DBD）后捐赠的供肝接受者进行了回顾性分析。比较两组的生存率和并发症发生率。然后使用考克斯比例风险模型来识别预测DCD组IC发展的受体和供体因素。两组之间的1年患者或移植物存活率没有差异。DCD同种异体移植物未发生原发性无功能。两组的肝动脉并发症和吻合口胆管并发症相当。然而，DCD组发生IC的风险增加（13.7% vs 1%，P = 0.001）。对于50岁以上的供体，供体体重> 100 kg且总缺血时间>= 9小时可预测DCD组IC的发生。总之，接受DCD供体肝脏的受者IC发生率较高;然而，DCD供体的患者和移植物结局与DBD供体相当。仔细选择供体可以提高这些移植物的利用率。
use of donation after cardiac death (DCD) donor hepatic allografts is becoming more widespread; however, there have been published reports of increased graft failure from specific complications associated with this type of allograft. The complication of ischemic cholangiopathy (IC) has been reported to occur more frequently after the use of DCD hepatic allografts. We report the results of 52 liver transplants from DCD donors and the factors that influenced the development of IC. We conducted a retrospective review of all DCD and donation after brain death (DBD) donor liver recipients from September 2003 through December 2006 at a single institution. Survival and complication rates were compared between the 2 groups. The Cox proportional hazards model was then used to identify recipient and donor factors that predict the development of IC in the DCD group. There was no difference in 1-year patient or graft survival rates between the 2 groups. There was no incidence of primary nonfunction from the DCD allografts. Hepatic artery complications and anastomotic bile duct complications were comparable in the 2 groups. There was, however, an increased risk for the development of IC in the DCD group (13.7% versus 1 %, P = 0.001). Donor weight > 100 kg and total ischemia times >= 9 hours, in donors older than 50 years of age, predicted the development of IC in the DCD group. In conclusion, there is a higher incidence of IC in recipients receiving DCD donor livers; however, patient and graft outcomes with DCD donors remain comparable to those with DBD donors. Careful donor selection may improve utilization of these grafts.