Survival advantage for patients accepting the offer of a circulatory death liver transplant
Survival advantage for patients accepting the offer of a circulatory death liver transplant
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DOI：
10.1016/j.jhep.2018.12.033
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发表时间：
2019-05-01
影响因子：
25.7
通讯作者：
Pettigrew, Gavin J.
中科院分区：
文献类型：
--
作者：
Taylor, Rhiannon;Allen, Elisa;Pettigrew, Gavin J.
背景和目的：在过去的十年中，英国循环死亡后的捐赠（DCD）增加了两倍。然而，DCD肝移植后的结果比脑干死亡（DBD）肝移植后的捐赠更差。这项研究探讨了接受者是否应该接受一个“质量较差”的DCD器官或等待更长的时间为“更好”的DBD organ.Methods：数据收集了5,825例患者谁登记在择期等候名单上的第一个成人肝脏移植和3,949例患者谁接受了肝脏移植在英国1月1日至2015年12月31日。通过考克斯回归模型比较了2008年至2015年期间进行的死亡供体肝移植后的生存率，以评估接受DCD肝脏与推迟潜在DBD transplant.Results相比对患者生存率的影响：在3，949例肝移植中，共有953例（23%）使用了DCD供体。DCD移植后5年生存率低于DBD移植（69.1% [DCD] vs. 78.3% [DBD]; p < 0.0001：校正风险比[HR] 1.65; 95% CI 1.40-1.94）。在移植名单上登记的5，798名患者中，有1，325名（23%）死亡或在没有接受移植的情况下从名单上删除。接受DCD肝脏的患者的死亡风险调整后风险低于那些仍在等待潜在DBD器官的患者（调整后HR 0.55; 95% CI 0.47-0.65）。最大的生存获益是在那些最先进的肝脏疾病（调整HR 0.19; 95%CI 0.07-0.50）。结论：虽然DCD肝移植导致更糟糕的移植结果比DBD移植，个人的生存率提高接受DCD报价，特别是对于更严重的肝脏疾病的患者。DCD肝移植提高了英国上市患者的总生存率，应予以鼓励。简易总结：这项研究着眼于需要肝移植以挽救生命的患者;肝脏可以由心脏停止后死亡的人捐赠（心源性死亡后捐赠[DCD]）或脑损伤后不再支持生命（脑干死亡后捐赠[DBD]）。我们知道脑干死亡后捐赠的肝脏比心脏死亡后捐赠的肝脏功能更好，但是没有足够的肝脏供每个人使用，因此我们希望帮助患者决定是否更好地接受早期DCD肝脏，而不是等待更长的时间从DBD供体那里获得“更好”的肝脏。我们发现，如果患者尽快接受肝脏移植（DCD或DBD），特别是如果他们的肝脏疾病非常严重，他们更有可能存活。(C)2019年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Background & aims: Donation after circulatory death (DCD) in the UK has tripled in the last decade. However, outcomes following DCD liver transplantation are worse than for donation after brainstem death (DBD) liver transplants. This study examines whether a recipient should accept a "poorer quality" DCD organ or wait longer for a "better" DBD organ.Methods: Data were collected on 5,825 patients who were registered on the elective waiting list for a first adult liver-only transplant and 3,949 patients who received a liver-only transplant in the UK between 1 January 2008 and 31 December 2015. Survival following deceased donor liver transplantation performed between 2008 and 2015 was compared by Cox regression modelling to assess the impact on patient survival of accepting a DCD liver compared to deferring for a potential DBD transplant.Results: A total of 953 (23%) of the 3,949 liver transplantations performed utilised DCD donors. Five-year post-transplant survival was worse following DCD than DBD transplantation (69.1% [DCD] vs. 78.3% [DBD]; p < 0.0001: adjusted hazard ratio [HR] 1.65; 95% CI 1.40-1.94). Of the 5,798 patients registered on the transplant list, 1,325 (23%) died or were removed from the list without receiving a transplant. Patients who received DCD livers had a lower risk-adjusted hazard of death than those who remained on the waiting list for a potential DBD organ (adjusted HR 0.55; 95% CI 0.47-0.65). The greatest survival benefit was in those with the most advanced liver disease (adjusted HR 0.19; 95% CI 0.07-0.50).Conclusions: Although DCD liver transplantation leads to worse transplant outcomes than DBD transplantation, the individual's survival is enhanced by accepting a DCD offer, particularly for patients with more severe liver disease. DCD liver transplantation improves overall survival for UK listed patients and should be encouraged.Lay summary: This study looks at patients who require a liver transplant to save their lives; this liver can be donated by a person who has died either after their heart has stopped (donation after cardiac death [DCD]) or after the brain has been injured and can no longer support life (donation after brainstem death [DBD]). We know that livers donated after brainstem death function better than those after cardiac death, but there are not enough of these livers for everyone, so we wished to help patients decide whether it was better for them to accept an early offer of a DCD liver than waiting longer to receive a "better" liver from a DBD donor. We found that patients were more likely to survive if they accepted the offer of a liver transplant as soon as possible (DCD or DBD), especially if their liver disease was very severe. (C) 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.