Biliary complications after liver transplantation from donation after cardiac death donors: an analysis of risk factors and long-term outcomes from a single center.
Biliary complications after liver transplantation from donation after cardiac death donors: an analysis of risk factors and long-term outcomes from a single center.
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DOI：
10.1097/sla.0b013e3182104784
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发表时间：
2011-04
影响因子：
9
通讯作者：
D'Alessandro A
中科院分区：
文献类型：
--
作者：
Foley DP;Fernandez LA;Leverson G;Anderson M;Mezrich J;Sollinger HW;D'Alessandro A
这项研究评估了心脏死亡(DCD)供者肝移植后的长期结果、胆道并发症发生率和胆道并发症的危险因素。最近增加使用DCD供肝的热情因胆道并发症发生率高而减轻。DCD肝移植后胆道并发症的预测危险因素仍未完全确定。我们对1993年1月1日至2008年12月31日期间进行的1157例脑死亡(DBD)后捐献和87例DCD肝移植进行了回顾。比较DBD组和DCD组的患者和移植物存活率，以及移植后第一年的并发症发生率。用COX比例风险模型评估潜在危险因素的影响。在1年、5年、10年和15年，DCD组的患者存活率显著低于DBD组(DCD：84%、68%、54%、54%与DBD：91%、81%、67%、58%，p<；0.01)。在1年、5年、10年和15年，DCD组的移植物存活率也显著低于DBD组(DCD：69%、56%、43%、43%与DBD：86%、76%、60%、51%，p<；0.001)。胆道并发症(OBC)(DCD：47%vs DBD：26%，p<；0.01)和缺血性胆管病变(IC)(DCD：34%vs DBD：1%，p<；0.01)明显高于DCD组。供者年龄(HR：1.04，P<；0.01)和供者年龄&40岁(HR：3.13，P<；0.01)是OBC发生的重要危险因素。多因素分析显示，冷缺血时间(CIT)和8小时(HR：2.46，p=0.05)、供者年龄&Gt；40(HR：2.90，p<；0.01)显著增加IC的风险。DCD肝移植后患者和移植物的长期存活率仍然显著较低，但与DBD肝移植相比可以接受。供者年龄和CIT>；8小时是缺血性胆管病发展的最强预测因子。仔细选择较年轻的DCD供者，尽量减少CIT，可能会限制严重胆道并发症的发生率，并提高DCD供体肝脏的成功利用。
This study evaluates the long-term outcomes, biliary complication rates, and risk factors for biliary complications after liver transplantation from donation after cardiac death (DCD) donors. Recent enthusiasm toward increased use of DCD donor livers is mitigated by high biliary complication rates. Predictive risk factors for the development of biliary complications after DCD liver transplantation remain incompletely defined. We performed a retrospective review of 1157 donation after brain death (DBD) and 87 DCD liver transplants performed between January 1, 1993 and December 31, 2008. Patient and graft survivals, and complication rates within the first year of transplantation were compared between DBD and DCD groups. Cox proportional hazards models were used to assess the influence of potential risk factors. Patient survival was significantly lower in the DCD group compared to the DBD group at 1, 5, 10 and 15 years (DCD: 84%, 68%, 54%, 54% vs. DBD: 91%, 81%, 67%, 58%, p<0.01). Graft survival was also significantly lower in the DCD group compared to the DBD group at 1, 5, 10 and 15 years (DCD: 69%, 56%, 43%, 43% vs. DBD: 86%, 76%, 60%, 51%, p<0.001). Rates of overall biliary complications (OBC) (DCD: 47% vs. DBD: 26%, p<0.01) and ischemic cholangiopathy (IC) (DCD: 34% vs. DBD: 1%, p<0.01) were significantly higher in the DCD group. Donor age (HR: 1.04, p<0.01) and donor age >40 years (HR: 3.13, p < 0.01) were significant risk factors for the development of OBC. Multivariate analysis revealed cold ischemic time (CIT) >8 hours (HR: 2.46, p=0.05), donor age >40 (HR: 2.90, p< 0.01) significantly increased the risk of IC. Long-term patient and graft survival after DCD liver transplantation remain significantly lower but acceptable when compared to DBD liver transplants. Donor age and CIT >8 hours are the strongest predictors for the development of ischemic cholangiopathy. Careful selection of younger DCD donors and minimizing CIT may limit the incidence of severe biliary complications and improve the successful utilization of DCD donor livers.