In situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival

被引：219

作者：

Watson, Christopher J. E. ^{[1
,2
,3
,4
]}

Hunt, Fiona ^{[5
]}

Messer, Simon ^{[6
]}

Currie, Ian ^{[5
]}

Large, Stephen ^{[6
]}

Sutherland, Andrew ^{[5
]}

Crick, Keziah ^{[4
]}

Wigmore, Stephen J. ^{[5
,7
]}

Fear, Corrina ^{[4
]}

Cornateanu, Sorina ^{[5
]}

Randle, Lucy, V ^{[8
]}

Terrace, John D. ^{[5
]}

Upponi, Sara ^{[9
]}

Taylor, Rhiannon ^{[10
]}

Allen, Elisa ^{[10
]}

Butler, Andrew J. ^{[1
,2
,3
,4
]}

Oniscu, Gabriel C. ^{[5
,7
]}

机构：

[1] Univ Cambridge, Addenbrookes Hosp, Dept Surg, Cambridge, England

[2] Univ Cambridge Collaborat Newcastle Univ & Partne, Cambridge Biomed Res Ctr, NIHR, Cambridge, England

[3] Univ Cambridge Collaborat Newcastle Univ & Partne, NIHR, BTRU, Cambridge, England

[4] Cambridge Univ Hosp NHS Trust, Addenbrookes Hosp, Cambridge Transplant Unit, Cambridge, England

[5] Royal Infirm Edinburgh NHS Trust, Edinburgh Transplant Ctr, Scottish Liver Transplant Unit, Little France Crescent, Edinburgh, Midlothian, Scotland

[6] Royal Papworth Hosp, Cambridge, England

[7] Univ Edinburgh, Dept Clin Surg, Edinburgh, Midlothian, Scotland

[8] OrganOx Ltd, Magdalen Ctr, Oxford, England

[9] Cambridge Univ Hosp NHS Trust, Addenbrookes Hosp, Dept Radiol, Cambridge, England

[10] NHS Blood & Transplant, Stat & Clin Studies, Bristol, Avon, England

来源：

AMERICAN JOURNAL OF TRANSPLANTATION | 2019年 / 19卷 / 06期

关键词：

clinical research; practice; donors and donation; donation after circulatory death (DCD); extracorporeal membrane oxygenation (ECMO); liver transplantation; hepatology; surgical technique; EXTRACORPOREAL MEMBRANE-OXYGENATION; EARLY ALLOGRAFT DYSFUNCTION; HEART-BEATING DONORS; CARDIAC DEATH; REGIONAL PERFUSION; HCO3-UMBRELLA; TRANSPLANTATION; MODEL; MORTALITY; INJURY;

D O I：

10.1111/ajt.15241

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Livers from controlled donation after circulatory death (DCD) donors suffer a higher incidence of nonfunction, poor function, and ischemic cholangiopathy. In situ normothermic regional perfusion (NRP) restores a blood supply to the abdominal organs after death using an extracorporeal circulation for a limited period before organ recovery. We undertook a retrospective analysis to evaluate whether NRP was associated with improved outcomes of livers from DCD donors. NRP was performed on 70 DCD donors from whom 43 livers were transplanted. These were compared with 187 non-NRP DCD donor livers transplanted at the same two UK centers in the same period. The use of NRP was associated with a reduction in early allograft dysfunction (12% for NRP vs. 32% for non-NRP livers, P = .0076), 30-day graft loss (2% NRP livers vs. 12% non-NRP livers, P = .0559), freedom from ischemic cholangiopathy (0% vs. 27% for non-NRP livers, P < .0001), and fewer anastomotic strictures (7% vs. 27% non-NRP, P = .0041). After adjusting for other factors in a multivariable analysis, NRP remained significantly associated with freedom from ischemic cholangiopathy (P < .0001). These data suggest that NRP during organ recovery from DCD donors leads to superior liver outcomes compared to conventional organ recovery.

引用

页码：1745 / 1758

页数：14

共 39 条

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