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在患有MELD超过35岁的患者中进行DCD肝移植

Raphael P H Meier^1,2, Miguel Nunez¹, Shareef M Syed¹

¹Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States.

Frontiers in immunology

|September 21, 2023

概括

循环死亡 (DCD) 之后的捐赠肝移植 (LT) 对于具有高末期肝病模型 (MELD) 评分的接受者来说是可行的,在选定的情况下,显示出与脑死亡 (DBD) 后捐赠者相比的生存率. 然而,如果没有仔细的捐赠者/接受者选择,结果会更糟.

科学领域:

肝病学肝病学是一种肝病学.
移植手术移植手术
器官捐赠器官捐赠器官捐赠器官捐赠器官捐赠器官捐赠器官捐赠器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器

背景情况:

循环死亡 (DCD) 肝移植 (LT) 后的捐赠在美国,对于末期肝病 (MELD) ≥35的患者来说,占所有LT的不到1%.
该研究调查了DCD-LT在临界高MELD分数的接受者中的可行性和结果.

研究的目的:

评估DCD-LT对MELD≥35.5的受体的可行性和结果.
在这个高风险人群中,将DCD-LT结果与脑死亡 (DBD) 后的捐赠LT进行比较.

主要方法:

来自UCSF (n=41) 和UNOS (n=375) 队列的接受者数据分析,移植时实验室MELD≥35.
使用多变量考克斯回归和倾向分数匹配来比较DCD-LT和DBD-LT的结果.

主要成果:

在UCSF队列中,DCD-LT (85%) 和DBD-LT (86%) 的5年患者存活率相似.
UNOS队列显示DCD-LT是移植损失的风险因素 (HR:1.5),但对于MELD 35-36接受者来说,这并不重要.
较年轻的供体年龄 (<30岁) 与DCD受体的移植损失风险降低有关;胆道并发症和排斥率在DCD和DBD组之间是可比的.

结论:

DCD-LT是可行的,可以在高度精选的接受者/捐赠者对中产生与DBD-LT相似的存活率,MELD ≥35.
如果没有严格的选择标准,DCD-LT的结果仍然低于DBD-LT,这凸显了仔细匹配的重要性.

关键词:

急性排斥急性排斥慢性拒绝慢性拒绝大脑死亡后的捐赠.在循环死亡后的捐赠.对于末期肝病得分的高模型.缺血 - 再输血缺血 - 再输血肝移植肝移植肝移植造成功能衰竭.

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