POLICIES IN EUROPE ON MARGINAL QUALITY DONOR LIVERS
POLICIES IN EUROPE ON MARGINAL QUALITY DONOR LIVERS
复制标题
DOI：
10.1016/s0140-6736(94)90294-1
复制
发表时间：
1994-11-26
期刊：
影响因子：
168.9
通讯作者：
MCMASTER, P
中科院分区：
文献类型：
--
作者：
MIRZA, DF;GUNSON, BK;MCMASTER, P
供体肝脏的短缺导致几个肝脏移植中心扩大了对供体适合性的定义。我们评估了来自边缘供者的肝移植的功能和对使用此类器官的态度。在18个月的时间里，英国伯明翰连续213例肝移植中有30例来自边缘供者(酒精中毒史、肝功能异常、药物过量包括扑热息痛、晚期心血管疾病、败血症、长期低血压[收缩压1小时]、大剂量变力药物使用)。这些捐赠者中有16人曾被英国其他肝脏移植中心拒绝，其中11人是基于健康原因。对照组为同一时期“良好”供者(n=183)的移植物。所有30个移植物的早期功能均令人满意，但第1天(p=0.004)和血清天冬氨酸氨基转移酶峰值(p=0.0008)均高于对照移植物。两组1年的移植物存活率和患者存活率相似(分别为72%比73%和80%比82%)。为了评估人们对边缘供者肝脏的态度，一份概述了这30名捐赠者的详细信息的问卷被发送到欧洲肝脏移植组的80个中心，其中60个进行了回复。边缘供者的即刻拒绝率中位数为7/30(0~18)，直接接受率中位数仅为11/30(1~26)。较大的中心选择性较低，拒绝率明显较低(p=0.03)。这些结果表明，由于欧洲现有的肝脏捐赠者标准，可用的捐赠者肝脏正因医疗原因而不必要地被拒绝。
Shortage of donor livers has led several liver transplant centres to widen their definition of liver donor suitability. We have assessed the function of liver grafts from ''marginal'' donors and attitudes to use of such organs.Over an 18-month period, livers used in 30 of 213 consecutive liver transplantations in Birmingham, UK, came from marginal donors (history of alcoholism, abnormal liver function test results, drug overdose that included paracetamol, advanced cardiovascular disease, sepsis, lengthy hypotension [systolic blood pressure 1 h], high-dose inotropic drug use). 16 of these donors had been refused by other UK liver transplant centres, 11 on medical grounds. The controls were grafts retrieved from ''good'' donors (n=183) during the same period. All 30 grafts showed satisfactory early function but had greater day 1 (p=0.004) and peak serum aspartate aminotransferase (p=0.0008) values than control grafts. Graft and patient survival at 1 year in the two groups was similar (72% vs 73% and 80% vs 82%, respectively). To assess attitudes to marginal donor livers, a questionnaire outlining the details of these 30 donors was sent to the 80 centres in the European Liver Transplant Group, and 60 replied. Median immediate refusal rate of the marginal donors was 7/30 (range 0-18) and median outright acceptance rate was only 11/30 (1-26). Larger centres were less selective, with a significantly lower refusal rate (p=0.03).These results indicate that, because of existing liver donor criteria within Europe, usable donor livers are being unnecessarily refused on medical grounds.