Interpreting Outcomes in DCDD Liver Transplantation: First Report of the Multicenter IDOL Consortium
Interpreting Outcomes in DCDD Liver Transplantation: First Report of the Multicenter IDOL Consortium
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DOI：
10.1097/tp.0000000000001656
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发表时间：
2017-05-01
期刊：
影响因子：
6.2
通讯作者：
Abt，Peter L.
中科院分区：
文献类型：
--
作者：
Goldberg，David S.;Karp，Seth J.;Abt，Peter L.
背景在美国，5% 的成人肝移植受者在循环死亡测定 (DCDD) 后接受移植物捐赠。对缺血性胆管病（IC）这种弥漫性肝内狭窄疾病的担忧限制了 DCDD 的更广泛使用。单中心报告显示结果差异很大。方法 10 个中心通过研究电子数据捕获数据库以电子方式输入 2005 年至 2013 年期间收集的回顾性去识别数据。我们的主要结局是出现与 IC 一致的肝内胆道狭窄。结果 DCDD 移植后 6 个月内，162 名 (21.8%) 患者出现胆道狭窄，其中 88 名 (11.8%) 表现出与 IC 一致的肝内结构。 10 个中心之间未经调整的 6 个月 IC 率差异显着（P=0.006），从 6.3% 到 25.9%。与 6 个月内 IC 风险增加相关的唯一因素是 Roux-en-Y 肝空肠吻合术（相对于导管到导管）（比值比，3.06；95% 置信区间，1.52-6.16；P= 0.002）。对于具有 IC 的 DCDD 受者，6 个月时移植失败率高出 3 倍以上（IC 的比值比为 3.36；95% 置信区间为 1.95-5.79）。 结论 改善肝移植联盟的 DCDD 的大量综合经验的第一份报告表明各中心之间 IC 存在显着差异，胆道狭窄作为移植失败危险因素的重要性，并且没有验证其他小型研究中发现的 IC 危险因素。
BackgroundIn the United States, 5% of adult liver transplant recipients receive a graft donation after circulatory determination of death (DCDD). Concerns for ischemic cholangiopathy (IC), a disease of diffuse intrahepatic stricturing limits broader DCDD use. Single-center reports demonstrate large variation in outcomes.MethodsRetrospective deidentified data collected between 2005 and 2013 were entered electronically by 10 centers via a Research Electronic Data Capture database. Our primary outcome was development of intrahepatic biliary strictures consistent with IC.ResultsWithin 6 months post-DCDD transplant, 162 (21.8%) patients developed a biliary stricture, of which 88 (11.8%) exhibited intrahepatic structuring consistent with IC. Unadjusted 6-month IC rate among the 10 centers varied significantly (P= 0.006) from 6.3% to 25.9%. The only factor associated with increased risk of IC within 6 months was Roux-en-Y hepaticojejunostomy (vs duct-to-duct)(odds ratio, 3.06; 95% confidence interval, 1.52-6.16; P= 0.002). Graft failure by 6 months was more than 3 times higher for DCDD recipients with IC (odds ratio for IC, 3.36; 95% confidence interval, 1.95-5.79).ConclusionsThis first report of the large combined experience with DCDD from the Improving DCDD Outcomes in Liver Transplant consortium demonstrates significant differences in IC among centers, the importance of biliary strictures as a risk factor for graft failure, and does not validate other risk factors for IC found in smaller studies.
影响因子：
2.5
作者：
Gunasekaran G;Sharma J;Mosna LC;Bodin R;Wolf DC
通讯作者：
Wolf DC