肝脏配对交换:美国单一中心的经验 - - 配对,链条和兼容配对的使用
Tarunjeet Klair1, Danielle Fritze, Glenn Halff
1Malu & Carlos Alvarez Center for Transplantation, Hepatobiliary Surgery and Innovation University of Texas Health San Antonio, San Antonio, Texas, USA.
概括
肝脏配对交换 (LPE) 克服了捐赠者-接受者不兼容性,增加了获得活体捐赠者肝脏移植的机会. 这一策略成功促进了23次移植,改善了患者的治疗结果.
科学领域:
- 移植医学 移植医学
- 器官捐赠和移植 器官捐赠和移植
- 手术创新 在外科创新.
背景情况:
- 美国持续存在的器官短缺影响了肝移植的获取.
- 活体供体肝移植在及时移植和减少等候名单死亡率方面未得到充分利用.
- 捐赠者-接受者不相容性 (大小,解剖学,血型) 限制了活体捐赠者的肝移植活力.
研究的目的:
- 在机构层面评估肝脏配对交易所 (LPE) 的实施和影响.
- 评估LPE作为增加获得肝移植的策略.
- 分析进行的LPE的类型和结果.
主要方法:
- 开发了针对LPE的特定教育材料,同意表以及选择标准.
- 实施LPE作为一种策略,以促进不兼容对之间的移植.
- 包括利他主义的非定向捐助者来启动交换链.
主要成果:
- 在2019年至2023年10月期间进行了11次LPEs,导致23次活体供体肝移植.
- 针对不同情景进行便利移植,包括互补不兼容的对,兼容的对和非定向的供体链.
- 成功移植了23名接受者,其中包括一名儿科患者.
结论:
- 肝脏配对交换显著改善了该机构获得肝脏移植的机会.
- 伦理性LPE需要量身定制的患者教育,风险减轻和效益最大化.
- 活体肝移植是一种可行的策略,可以克服捐赠者-接受者不兼容性,并扩大活体捐赠者肝移植计划.
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