The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: the untold story.
The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: the untold story.
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DOI：
10.1016/j.surg.2009.06.052
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发表时间：
2009-10
期刊：
影响因子：
3.8
通讯作者：
Abecassis MM
中科院分区：
文献类型：
--
作者：
Skaro AI;Jay CL;Baker TB;Wang E;Pasricha S;Lyuksemburg V;Martin JA;Feinglass JM;Preczewski LB;Abecassis MM
心脏死亡后捐献（DCD）供体的肝移植（LT）越来越多地用于解决器官短缺问题。尽管有令人鼓舞的报告，但标准的生存指标高估了DCD肝脏的有效性。我们研究了器官衰竭和资源利用的模式，动力学和预测因素，以更全面地描述DCD LT后的结局。我们回顾了本机构32例DCD和237例脑死亡后捐献（DBD）LT受者的结局。与DBD受体相比，DCD肝脏受体的移植失败风险高2.1倍，重新上市风险高2.5倍，再次移植风险高3.2倍。DCD接受者的胆道并发症发生率高31.6%，缺血性胆管病（IC）发生率高35.8%。IC主要与DCD LT后观察到的移植物失败风险较高有关。IC DCD受者的再住院频率更高，住院时间更长，需要更多的侵入性胆道手术。与较高的并发症发生率相关，DCD接受者需要更多的资源利用。在决定推广DCD LT时应考虑这些更细粒度的数据。有必要修改肝脏分配政策，以解决DCD移植失败的弱势群体。
Liver transplantation (LT) from Donation after Cardiac Death (DCD) donors is increasingly being used to address organ shortages. Despite encouraging reports, standard survival metrics have overestimated the effectiveness of DCD livers. We examined the mode, kinetics and predictors of organ failure and resource utilization to more fully characterize outcomes after DCD LT. We reviewed the outcomes for 32 DCD and 237 Donation after Brain Death (DBD) LT recipients at our institution. Recipients of DCD livers had a 2.1 times greater risk of graft failure, a 2.5 times greater risk of re-listing, and a 3.2 times greater risk of re-transplantation compared to DBD recipients. DCD recipients had a 31.6% higher incidence of biliary complications and a 35.8% higher incidence of ischemic cholangiopathy (IC). IC was primarily implicated in the higher risk of graft failure observed after DCD LT. DCD recipients with IC experienced more frequent re-hospitalizations, longer lengths of stay, and required more invasive biliary procedures. Related to higher complication rates, DCD recipients necessitated greater resource utilization. This more granular data should be considered in the decision to promote DCD LT. Modification of liver allocation policy is necessary to address those disadvantaged by a failing DCD graft.
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影响因子：
0.9
作者：
Kaczmarek, B.;Manas, M. D.;Talbot, D.
通讯作者：
Talbot, D.
影响因子：
4.6
作者：
Maheshwari, Anurag;Maley, Warren;Thuluvath, Paul J.
通讯作者：
Thuluvath, Paul J.
影响因子：
6.2
作者：
Reich, DJ;Munoz, SJ;Manzarbeitia, CY
通讯作者：
Manzarbeitia, CY
影响因子：
6.2
作者：
Whiting, James F.;Delmonico, Francis;Lipkowitz, George
通讯作者：
Lipkowitz, George
影响因子：
8.8
作者：
Stewart, Z. A.;Cameron, A. M.;Segev, D. L.
通讯作者：
Segev, D. L.