在美国拒绝了DCD肝脏之后,移植候选人结果
Tanveen Ishaque1, Mackenzie A Eagleson2, Mary G Bowring2
1New York University Langone Transplant Institute, New York, NY.
Transplantation
|September 20, 2023
概括
接受血液循环死亡后 (DCD) 捐赠者的肝脏供应可显著改善移植候选人的生存率. 即使是来自老年或并发性病的捐赠者的肝脏也能为长期生存带来巨大的好处,鼓励增加DCD肝脏利用率.
科学领域:
- 移植免疫学 移植免疫学
- 器官捐献研究器官捐献研究
- 肝病学 肝病学是一种肝病学.
背景情况:
- 循环死亡 (DCD) 后的捐赠扩大了肝移植的捐赠者池.
- 尽管扩张,但DCD肝脏的废弃率很高.
- 来自老年捐赠者或患有并发病的人的DCD肝脏的使用仍然存在争议.
研究的目的:
- 评估接受DCD肝脏提供的人与拒绝的人之间的肝移植候选人的长期生存结果.
- 量化与接受DCD肝脏供应相关的生存益处,包括来自高风险捐赠者的供应.
主要方法:
- 对2009-2020年美国注册数据的分析.
- 对1564个DCD肝脏接受者和16981个拒绝者之间的结局进行比较.
- 利用竞争性风险框架和考克斯回归来估计生存益处.
主要成果:
- 在10年内,50.9%的拒绝者死亡或从等待名单中删除.
- DCD接受者10年死亡率明显降低 (35.4%与48.9%相比).
- 接受DCD的报价与46%的死亡风险降低有关 (aHR为0.54).
结论:
- 接受DCD肝脏提供给肝脏移植候选人提供了显著的长期生存益处.
- 即使接受来自老年捐赠者或患有并发症的捐赠者的肝脏,这些好处仍然存在.
- 应促进增加DCD肝脏的恢复和利用,以改善患者的治疗结果.
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