Liver transplantation from Maastricht category 2 non-heart-beating donors
Liver transplantation from Maastricht category 2 non-heart-beating donors
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DOI：
10.1097/01.tp.0000085043.78445.53
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发表时间：
2003-10-15
期刊：
影响因子：
6.2
通讯作者：
Máñez, R
中科院分区：
文献类型：
--
作者：
Otero, A;Gómez-Gutiérrez, M;Máñez, R
背景资料。肝移植供不应求，身体供体器官供不应求。非心脏跳动供体(NHBD)可能是增加身体供体池的一种替代方法。马斯特里赫特2类NHBD的20例肝移植与心脏跳动供者(HBD)的40例肝移植的结果进行了比较。心肺复苏(CPR)失败后，采用心肺支持(CPS)联合胸腹按压(n=6)和低温或常温体外循环(CPB)(n=7)保存器官。对可能影响马斯特里赫特2类NHBD患者肝脏预后的因素也进行了调查。在至少2年的随访期内，马斯特里赫特2类NHBD的精算患者和移植物存活率分别为80%和55%。与来自HBD的肝脏相比，来自这些捐赠者的器官移植与原发性无功能、胆道并发症和更严重的初始肝功能障碍的发生率显著相关。用CPS保存的NHBD的肝移植物存活率为83%，而用CPB保存的NHBD肝移植存活率为42%。无论是低温还是常温，CPR或CPS热缺血时间不超过130min，CPB时间不超过150min，均无移植物失败。如果CPR或CPS期间热缺血时间不超过130分钟，则可使用马斯特里赫特2型NHBD的肝脏进行移植。CPR后低温或常温CPB可额外保存肝脏活力150分钟。
Background. The demand for liver transplantation has increasingly exceeded the supply of cadaver donor organs. Non-heart-beating donors (NHBDs) may be an alternative to increase the cadaver donor pool.Methods. The outcome of 20 liver transplants from Maastricht category 2 NHBDs is compared with 40 liver transplants from heart-beating donors (HBDs). After unsuccessful cardiopulmonary resuscitation (CPR), cardiopulmonary support (CPS) with simultaneous application of chest and abdominal compression (n = 6), and cardiopulmonary bypass (CPB; n = 14), which was hypothermic (n = 7) or normothermic (n = 7), were used to preserve the organs from NHBDs. Factors that may influence the outcome of livers from Maastricht category 2 NHBDs were also investigated.Results. With a minimum follow-up of 2 years, actuarial patient and graft survivals with livers from Maastricht category 2 NHBDs were 80% and 55%, respectively. Transplantation of organs from these donors was associated with a significantly higher incidence of primary nonfunction, biliary complications, and more severe initial liver dysfunction compared with livers from HBDs. Graft survival was 83% in livers from NHBDs preserved with CPS and 42% in those maintained with CPB. No graft failed if the duration of warm ischemia did not exceed 130 min with CPR or CPS, and if the period of CPB did not surpass 150 min when this method was used after CPR, regardless if it was hypothermic or normothermic.Conclusion. Livers from Maastricht type 2 NHBDs may be used for transplantation if the period of warm ischemia during CPR or CPS does not exceed 130 min. Hypothermic or normothermic CPB after CPR preserves liver viability for an additional 150 min.