在基于KDPI的分配系统中,使用ECMO支持的捐赠者评估移植
Peter J Altshuler1, Devon J Pace1, William A Preston1
1Department of Surgery, Thomas Jefferson University, Philadelphia, PA.
Transplantation direct
|October 13, 2023
概括
通过体外膜氧化 (ECMO) 的捐赠者进行移植可以扩大捐赠者池. 虽然VA-ECMO脏的存活率与标准捐赠者的存活率相当,但VV-ECMO脏的移植损失风险更高.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 移植 移植 移植 移植
- 支持心肺血管的支持.
背景情况:
- 在器官捐赠者中,体外膜氧化 (ECMO) 的支持历来引起了对移植品质的担忧.
- 本研究调查了ECMO支持非捐赠目的的捐赠者的移植结果.
研究的目的:
- 评估使用ECMO支持的捐赠者的移植用于移植的安全性和有效性.
- 为了比较ECMO捐赠者 (VA-ECMO和VV-ECMO) 和非ECMO捐赠者之间的移植结果,按脏捐赠者概况指数 (KDPI) 分层.
主要方法:
- 对器官采购组织和移植网络数据库的回顾性审查.
- 来自VA-ECMO和VV-ECMO捐赠者的移植与KDPI分层非ECMO捐赠者的移植的比较.
- 多变量回归分析以评估ECMO支持和预测移植存活的供体因素.
主要成果:
- 分析了来自78个ECMO捐赠者 (80个VA-ECMO,48个VV-ECMO) 的128例移植.
- VA-ECMO捐赠脏的延迟移植功能和移植后的功能与KDPI匹配的非ECMO捐赠者相似.
- 与低KDPI非ECMO脏相比,VA-ECMO脏的移植存活率高于或类似,而VV-ECMO脏的存活率低于,除了最低KDPI组外.
- VV-ECMO,但不是VA-ECMO,与移植损失的风险增加有关 (HR 2.18).
- 高KDPI,较老的供体年龄,较高的BMI,高血压和糖尿病是ECMO供体的危险因素.
结论:
- 从精心挑选的ECMO捐赠者进行脏移植可以安全地增加可用的捐赠者池.
- VA-ECMO捐赠者代表了移植的可行选择.
- 需要进一步的研究,以确定利用ECMO支持的捐赠者的脏的最佳做法,特别是VV-ECMO捐赠者的脏.
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