In situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival
In situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival
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DOI：
10.1111/ajt.15241
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发表时间：
2019-06-01
影响因子：
8.8
通讯作者：
Oniscu, Gabriel C.
中科院分区：
文献类型：
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作者：
Watson, Christopher J. E.;Hunt, Fiona;Oniscu, Gabriel C.
循环死亡(DCD)供者的受控捐献的肝脏有较高的无功能、功能不良和缺血性胆管病的发生率。原位常温区域灌流(NRP)在器官恢复前的有限时间内使用体外循环恢复死后腹部器官的血液供应。我们进行了一项回顾性分析，以评估NRP是否与DCD捐赠者肝脏预后的改善有关。对70例DCD供者施行了NRP术，其中43例肝移植。这与同一时期在同一两个英国中心移植的187个非NRP DCD供体肝脏进行了比较。使用NRP可减少早期移植物功能障碍(NRP组为12%，非NRP组为32%，P=.0076)，30天移植物丢失(NRP组为2%，非NRP组为12%，P=.0559)，无缺血性胆管病变(0%对非NRP组，P<；.0001)，以及较少的吻合口狭窄(7%对非NRP组，P=.0041)。在多变量分析中调整了其他因素后，NRP仍然与无缺血性胆管病变显著相关(P<；.0001)。这些数据表明，与传统的器官回收相比，在DCD捐赠者的器官回收过程中使用NRP会导致更好的肝脏结局。
Livers from controlled donation after circulatory death (DCD) donors suffer a higher incidence of nonfunction, poor function, and ischemic cholangiopathy. In situ normothermic regional perfusion (NRP) restores a blood supply to the abdominal organs after death using an extracorporeal circulation for a limited period before organ recovery. We undertook a retrospective analysis to evaluate whether NRP was associated with improved outcomes of livers from DCD donors. NRP was performed on 70 DCD donors from whom 43 livers were transplanted. These were compared with 187 non-NRP DCD donor livers transplanted at the same two UK centers in the same period. The use of NRP was associated with a reduction in early allograft dysfunction (12% for NRP vs. 32% for non-NRP livers, P = .0076), 30-day graft loss (2% NRP livers vs. 12% non-NRP livers, P = .0559), freedom from ischemic cholangiopathy (0% vs. 27% for non-NRP livers, P < .0001), and fewer anastomotic strictures (7% vs. 27% non-NRP, P = .0041). After adjusting for other factors in a multivariable analysis, NRP remained significantly associated with freedom from ischemic cholangiopathy (P < .0001). These data suggest that NRP during organ recovery from DCD donors leads to superior liver outcomes compared to conventional organ recovery.