Experience Using Extended Criteria Donors in First 100 Cases of Deceased Donor Liver Transplantation in Japan
Experience Using Extended Criteria Donors in First 100 Cases of Deceased Donor Liver Transplantation in Japan
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DOI：
10.1016/j.transproceed.2012.01.010
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发表时间：
2012-03-01
影响因子：
0.9
通讯作者：
Oota, M.
中科院分区：
文献类型：
--
作者：
Furukawa, H.;Taniguchi, M.;Oota, M.
由于日本严重的器官短缺，使用扩展标准（EC）捐赠者不可避免地会增加死亡捐赠者的数量。然而，这种做法对接受者结果的影响尚未得到澄清。我们分析了供体和受体因素，以确定这些因素，特别是来自EC供体的因素是否会影响早期受体结果。1999年2月至2011年1月，在日本进行了100例死亡肝移植手术，包括85例连续的成人病例（年龄>= 18岁），研究了6个受体和16个供体因素是否影响受体3个月（90天）的生存。单因素分析显示，终末期肝病模型（MELD）评分>= 25 (P = 0.018)，供体年龄>= 55岁（P = 0.040），冷缺血时间>= 10小时（P = 0.00013）显著降低3个月生存率。多因素分析证实了MELD评分>= 25 （P = 0.0133，比值比[OR] = 12.3, 95%可信区间[CI] = 1.7 ~ 90.3）、供体年龄>= 55岁（P = 0.013, OR = 14.0, 95% CI = 1.6 ~ 119.5）、CIT >= 10小时（P = 0.0024, OR = 67.6, 95% CI = 4.5 ~ 1024.9）三个不利因素的独立贡献。阳性因子0、1、2、3的3个月生存率分别为100% （n = 34）、94.4% （n = 36）、53.8% （n = 13）、0% (n = 2) （P < 0.0001）。综上所述，为了提高受者的短期存活率，减少CIT是第一要务。长远而言，我们必须推动死者捐赠，缩短轮候时间，以降低受者MELD评分，并修订分配制度，以优先考虑本地地区，以尽量减少损失。
Because of the serious organ shortage in Japan, the use of extended criteria (EC) donors is inevitable to increase the number of deceased donors. However, the influence of this practice on recipient outcomes has not been clarified yet. We analyzed donor and recipient factors to determine whether those factors, especially from EC donors impacted early recipient outcomes. From February 1999 to January 2011, 100 deceased liver transplantations were performed in Japan, including 85 consecutive adult cases (age >= 18 years) who were studied to evaluate whether 6 recipient and 16 donor factors affected 3-month (90-day) recipient survival. Upon univariate analysis, Model for End-stage Liver Disease (MELD) score >= 25 (P = .018), donor age >= 55 years (P = .040), and cold ischemia time (CIT) >= 10 hours (P = .00013) significantly reduced 3-month survival. Multivariate analysis confirmed the independent contributions of, three adverse factors including MELD score >= 25 (P = .0133, odds ratio [OR] = 12.3, 95% confidence interval [CI] = 1.7-90.3), donor age >= 55 years (P = .013, OR = 14.0, 95% CI = 1.6-119.5), and CIT >= 10 hours (P = .0024, OR = 67.6, 95% CI = 4.5-1024.9). Three-month recipient survivals with 0, 1, 2, and 3 positive factors were 100% (n = 34), 94.4% (n = 36), 53.8% (n = 13), and 0% (n = 2), respectively (P < .0001). In conclusion, to improve recipient short-term survivals, minimizing CIT is the first priority. In the long-term, we must promote deceased donation to reduce recipient MELD scores by shortening the waiting time, and revise the allocation system to minimize CIT by giving priority to the local area.