Favorable Outcomes After Liver Transplantation With Normothermic Regional Perfusion From Donors After Circulatory Death: A Single-center Experience
Favorable Outcomes After Liver Transplantation With Normothermic Regional Perfusion From Donors After Circulatory Death: A Single-center Experience
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DOI：
10.1097/tp.0000000000002391
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发表时间：
2019-05-01
期刊：
影响因子：
6.2
通讯作者：
Valdivieso, Andres
中科院分区：
文献类型：
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作者：
Ruiz, Patricia;Gastaca, Mikel;Valdivieso, Andres
背景循环死亡后的控制性捐献（cDCD）与缺血性胆管病和其他围手术期并发症的高发病率相关。为了避免这些并发症，我们实施了一项积极的cDCD肝移植（LT）方案，并进行了常温区域灌注（NRP）保存。方法.这是对从2015年1月至2017年6月期间使用NRP保存的cDCD LT前瞻性数据库中收集的数据进行的描述性分析，至少随访9个月。结果将57个潜在的cDCD供体连接到NRP系统。其中，46个肝脏在30个月内移植（80%的肝脏恢复率）。丙氨酸转氨酶的移植后峰值中位数为1136 U/L（220-6683 U/L）。7例（15%）患者出现再灌注后综合征，11例（23%）患者出现早期移植物功能障碍。在19个月的中期随访期内，没有诊断出缺血性胆管病的病例，也没有观察到移植物丢失。值得注意的是，13名供体年龄超过65岁，与年轻供体的围手术期和中期结果相当。结论.据我们所知，这代表了NRP保存的最大的已发表cDCD LT系列。我们的研究结果表明，用NRP保存的cDCD肝移植物似乎远远上级传统的快速恢复技术。
Background. Controlled donation after circulatory death (cDCD) has been associated with a high incidence of ischemic cholangiopathy and other perioperative complications. In an attempt to avoid these complications, we implemented an active protocol of cDCD liver transplant (LT) with normothermic regional perfusion (NRP) preservation. Methods. This is a descriptive analysis of data collected from a prospective date base of cDCD LT preserved with NRP from January 2015 to June 2017 with a minimum follow up of 9 months. Results. Fifty-seven potential cDCD donors were connected to the NRP system. Of these, 46 livers were transplanted over a 30-month period (80% liver recovery rate). The median posttransplant peak in alanine transaminase was 1136 U/L (220-6683 U/L). Seven (15%) patients presented postreperfusion syndrome and 11 (23%) showed early allograft dysfunction. No cases of ischemic cholangiopathy were diagnosed, and no graft loss was observed over a medium follow-up period of 19 months. Of note, 13 donors were older than 65 years, achieving comparable perioperative and midterm results to younger donors. Conclusions. As far as we know, this represents the largest published series of cDCD LT with NRP preservation. Our results demonstrate that cDCD liver grafts preserved with NRP appear far superior to those obtained by the conventional rapid recovery technique.