Donor eligibility criteria and liver graft acceptance criteria during normothermic regional perfusion: A systematic review.
Donor eligibility criteria and liver graft acceptance criteria during normothermic regional perfusion: A systematic review.
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DOI：
10.1002/lt.26512
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发表时间：
2022-10
期刊：
影响因子：
--
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中科院分区：
文献类型：
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接受循环性死亡(DCD)后捐献的肝移植在很大程度上仍然是一个“黑匣子”，特别是由于死亡阶段的不可预测性。腹部常温区域灌流(ANRP)可以在获取过程中早期逆转缺血性损伤，同时它可以使移植物活性测试解开这个黑匣子。这篇综述评估了目前评估肝脏存活能力的方案，以决定在非手术治疗期间接受还是拒绝。使用系统综述和荟萃分析(PRISMA)指南的首选报告项目，并搜索相关文献数据库。主要结果包括肝移植存活评估的标准。次要结果包括存活率、原发无功能(PNF)、早期功能障碍和胆道并发症。共有14篇文章被纳入分析。在所有方案中，综合标准被用于评估肝移植的适宜性。多达12项研究(86%)使用宏观评估，12项研究(86%)使用灌流液中丙氨酸转氨酶(ALT)水平，9项研究(%)使用显微镜评估，7项研究(50%)使用乳酸水平作为评估标准。循环死亡后无节制捐献的器官利用率(OUR)为16%，循环死亡后控制性捐赠的器官利用率为%。在uDCD中，使用最多的词义标准是ALT水平(31%)，而在cDCD中，使用最多的是宏观方面(48%)。术后并发症发生率：uDCD组13%(6%~25%)，cDCD组3%(2%~4%)。在uDCD组，移植物和患者的1年存活率分别为75%(66%-82%)和82%(75%-88%)。CDCD组1年移植物存活率为91%(89%~93%)，患者1年存活率为93%(91%~94%)。综上所述，目前使用的评估标准包括宏观方面和转氨酶水平。接受标准应根据供体类型定制，以防止uDCD出现不可接受的PNF率，并增加CDCD相对适度的OUR。
Acceptance of liver grafts from donations after circulatory death (DCD) largely remains a “black box,” particularly due to the unpredictability of the agonal phase. Abdominal normothermic regional perfusion (aNRP) can reverse ischemic injury early during the procurement procedure, and it simultaneously enables graft viability testing to unravel this black box. This review evaluates current protocols for liver viability assessment to decide upon acceptance or decline during aNRP. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guideline was used, and relevant literature databases were searched. The primary outcome consisted of criteria for liver graft viability assessment. Secondary outcomes included survival, primary nonfunction (PNF), early dysfunction, and biliary complications. A total of 14 articles were included in the analysis. In all protocols, a combination of criteria was used to assess suitability of the liver for transplantation. As many as 12 studies (86%) used macroscopic assessment, 12 studies (86%) used alanine transaminase (ALT) levels in perfusate, 9 studies (64%) used microscopic assessment, and 7 studies (50%) used lactate levels as assessment criteria. The organ utilization rate (OUR) was 16% for uncontrolled donation after circulatory death (uDCD) and 64% for controlled donation after circulatory death (cDCD). The most used acceptation criterion in uDCD is ALT level (31%), while in cDCD macroscopic aspect (48%) is most used. Regarding postoperative complications, PNF occurred in 13% (6%–25%) of uDCD livers and 3% (2%–4%) of cDCD livers. In uDCD, the 1‐year graft and patient survival rates were 75% (66%–82%) and 82% (75%–88%). In cDCD, the 1‐year graft and patient survival rates were 91% (89%–93%) and 93% (91%–94%), respectively. In conclusion, the currently used assessment criteria consist of macroscopic aspect and transaminase levels. The acceptance criteria should be tailored according to donor type to prevent an unacceptable PNF rate in uDCD and to increase the relatively modest OUR in cDCD.
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影响因子：
8.8
作者：
Oniscu, G. C.;Randle, L. V.;Watson, C. J. E.
通讯作者：
Watson, C. J. E.
影响因子：
3.7
作者：
Moher D;Shamseer L;Clarke M;Ghersi D;Liberati A;Petticrew M;Shekelle P;Stewart LA;PRISMA-P Group
通讯作者：
PRISMA-P Group
影响因子：
6.2
作者：
Otero, A;Gómez-Gutiérrez, M;Máñez, R
通讯作者：
Máñez, R
影响因子：
4.6
作者：
Schurink IJ;de Haan JE;Willemse J;Mueller M;Doukas M;Roest H;de Goeij FHC;Polak WG;Ijzermans JNM;Dutkowski P;van der Laan LJW;de Jonge J
通讯作者：
de Jonge J
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N