抗氧化剂提高了捐肝的存活率

StephenW

Donated liver survival rate improved by antioxidant
Published on February 21, 2013 at 11:12 AM ·


Researchers from Italy have found that the antioxidant, N-acetylcysteine (NAC), when injected prior to harvesting of the liver, significantly improves graft survival following transplantation. Results published in the February issue of Liver Transplantation, a journal of the American Association for the Study of Liver Diseases (AASLD), suggest that the NAC effect on early graft function and survival is higher when suboptimal organs are used.

A 2010 World Health Organization (WHO) report estimates that 22,000 liver transplants were performed worldwide, with nearly 18,500 from deceased donors. According to the Organ Procurement and Transplantation Network (OPTN) close to 16,000 U.S. patients are currently on the waiting list for a liver. Nearly 18,500 deceased donor transplants were performed between January and October 2012 in the U.S. OPTN reports that roughly 7,000 livers were recovered from deceased donors during the same time period.

“Liver transplantation is the standard treatment for end-stage liver disease,” explains lead author Dr. Francesco D’Amico from Padova University in Italy. “Antioxidants such as NAC could potentially reduce damage to deceased donor livers, improving graft function.” Studies have shown that ischemia-reperfusion injury (IFI)—damage to the liver tissue when blood supply returns to the liver after lack of oxygen (ischemia)—often occurs during storage and preservation of donated livers, and impacts early graft function post-transplantation.

For the present study researchers assigned 140 organs to adult candidates with liver disease undergoing their first transplant. An NAC infusion of 30 mg/kg was administered to one hour prior to liver procurement and another infusion of 300 mg (150mg/kg liver weight) through the portal vein before cross-clamping. There were 69 transplant candidates who received an NAC infused organ and 71 patients who had a standard transplant without NAC.

Results indicate that graft survival rates at 3 and 12 months were 93% and 90%, respectively, for patients receiving NAC infused livers; rates were 82% and 70% in the control group. Post-transplant complication rates were 23% for the NAC group and 51% in the control group. Analysis of the 61 patients receiving suboptimal livers the incidence of organ dysfunction was lower in the NAC group compared to controls at 15% and 32%, respectively.


Dr. D’Amico concludes, “Our study was the first randomized trial to investigate the use of NAC antioxidant infusion during the liver procurement procedure. We propose that NAC be used during organ harvesting to improve liver transplantation outcomes, particularly with the increased use of suboptimal organs. NAC has a good safety profile and the very low cost per patient, make this protocol highly cost-effective in consideration of grafts survival, length of hospital stays and post operative complications. Moreover we are performing further analyses to determine beneficial effects on the other organ procured with NAC protocol.”

In a related editorial published this month in Liver Transplantation the authors from the University of California, San Francisco (UCSF) and OneLegacy (Organ Procurement Organization, Los Angeles) highlight the importance and rarity of deceased organ donor research, such as the study by D’Amico et al., despite the fact that randomized clinical trials are essential to evidence-based medicine. Dr. Claus Niemann from the Department of Anesthesia and the Department of Surgery, Division of Transplantation at UCSF said, “Well-controlled deceased donor research is crucial to uncovering superior clinical practices that improve organ utilization and transplant outcomes. However, researchers are currently operating in a regulatory and legal vacuum since no review and oversight policies are established.”

Source: Liver Transplantation, Wiley

StephenW

从意大利研究人员发现，抗氧化剂，N-乙酰半胱氨酸（NAC），注射时之前收获的肝脏，大大提高了移植后的移植物的存活。结果发表在二月号的肝移植，一本杂志的美国肝病研究学会（AASLD），NAC早期移植物功能和生存的影响是最理想的器官时，。

2010年的世界卫生组织（WHO）的报告估计，全世界22,000例肝脏移植手术，有近18,500从死者捐赠。根据器官获取和移植网络（OPTN）近16000例美国患者目前的肝轮候册上的。在2012年一月至十月之间进行的，在相同的时间内恢复从死者捐赠大约7000的肝脏，美国OPTN报告的近18,500死者捐赠移植。

“肝移植是治疗终末期肝病的标准，解释说：”第一作者博士弗朗西斯达米科在意大利帕多瓦大学。 “抗氧化剂，如NAC可能会减少，以死者捐赠肝脏的损害，提高移植肾功能。”有研究表明，缺血再灌注损伤（IFI​​）的肝组织的损害时后返回到肝脏血液供应，氧气不足（缺血）常发生在贮藏保鲜捐赠的肝脏，并影响移植肾功能早期移植后。

对于本研究中研究者将140器官成年考生的经历他们的第一次移植的肝脏疾病。 30毫克/千克的NAC输注给药肝采购和另一输注300毫克（150mg/kg的肝脏重量）通过门静脉交叉夹紧之前的前一小时。有69位移植候选人谁收到了NAC注入有一个标准的无NAC移植的器官71例。

结果表明，在3个月和12个月的移植物存活率分别为93％和90％，分别为患者接受NAC注入肝脏率分别为82％和70％，对照组。移植后并发症发生率，NAC组分别为23％，51％，对照组。分析61例患者接受不理想的肝脏器官功能障碍的发病率显着低于NAC组相比，控制在15％和32％，分别。


达米科博士总结说：“我们的研究是第一个随机试验，以探讨使用NAC的抗氧化输液在肝脏采购过程中。我们建议NAC过程中使用活体摘取器官，以改善肝移植的成果，特别是最理想的器官使用量的增加。 NAC具有良好的安全性和非常低的病人的费用，使这个协议极具成本效益的考虑移植物存活，住院时间和术后并发症的长度。此外，我们进行进一步的分析，以确定其他器官采购与NAC协议的有利影响。“

在相关的社论发表在本月的肝移植的作者来自加州大学旧金山分校（UCSF）和OneLegacy（器官获取组织，洛杉矶）突出的重要性和稀有的死者的器官供体的研究，如D的研究达米科等，尽管事实上，随机临床试验是必不可少的，以循证医学。麻醉科和外科部，移植科在加州大学旧金山分校的克劳斯·尼曼博士说，“良好的控制死亡的捐赠者的研究发现卓越的临床实践，提高器官利用率和移植的结果是至关重要的。然而，研究人员目前正在运行中的监管和法律真空，因为没有审查和监督政策建立。“

来源：肝移植，威利