安全地扩大供体池：脑死亡捐赠者临时心脏骤停的历史

StephenW

Safely expanding the donor pool: Brain dead donors with history of temporary cardiac arrest

    Dieter P. Hoyer1,*,
    Andreas Paul1,
    Fuat Saner1,
    Anja Gallinat1,
    Zoltan Mathé1,
    Juergen W. Treckmann1,
    Maren Schulze1,
    Gernot M. Kaiser1,
    Ali Canbay2,
    Ernesto Molmenti3 and
    Georgios C. Sotiropoulos1

DOI: 10.1111/liv.12766

This article is protected by copyright. All rights reserved.

Issue
Vol. 35 Issue
Liver International

Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)


Author InformationPublication History
Author Information

    1    General, Visceral and Transplantation Surgery, University Hospital Essen, Germany
    2    Gastroenterology and Hepatology, University Hospital Essen, Germany
    3    Department of Surgery, North Shore University Hospital, Manhasset, New York, USA

* Corresponding author contact information:
Dieter P. Hoyer, MD
University Hospital Essen
Department of General, Visceral and Transplantation Surgery
Hufelandstr. 55
45127 Essen
Germany
Fon: 0049 201 723 84002
Fax: 0049 201 723 1113
[email protected]

    This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/liv.12766


Abstract
Background & Aim

Cardiac arrest (CA) in deceased organ donors can potentially be associated with ischemic organ injury, resulting in allograft dysfunction after liver transplantation (LT). The aim of this study was to analyze the influence of cardiac arrest in liver donors.

Methods

We evaluated 884 consecutive adult patients undergoing LT at our Institution from 09/2003-12/2011. Uni and multivariable analyses was performed to identify predictive factors of outcome and survival for organs from donors with (CA donor) and without (no CA donor) a history of cardiac arrest.

Results

We identified 77 (8.7%) CA donors. Median resuscitation time was 16.5 (1-150) minutes. Allografts from CA donors had prolonged CIT (p=0.016), were obtained from younger individuals (p<0.001), and had higher terminal pre-procurement AST and ALT (p<0.001) than those of no CA donors. 3-month, 1-year, and 5-year survival for recipients of CA donor grafts was 79%, 76% and 57% and 72.1%, 65.1%, and 53% for no CA donor grafts (log rank p=0.435). Peak AST after LT was significantly lower in CA donor organs than in no CA donor ones (886U/l vs 1321U/l; p=0.031). Multivariable analysis identified CIT as a risk factor for both patient and graft survival in CA donors.

Conclusion

This analysis represents the largest cohort of liver donors with a history of cardiac arrest. Reasonable selection of these donors constitutes a safe approach to the expansion of the donor pool. Rapid allocation and implantation with diminution of CIT may further improve the outcomes of livers from CA donors.

This article is protected by copyright. All rights reserved.

StephenW

安全地扩大供体池：脑死亡捐赠者临时心脏骤停的历史

    迪特尔P. Hoyer1，*，
    安德烈亚斯Paul1，
    Fuat Saner1，
    安雅Gallinat1，
    佐尔坦Mathé1，
    克林斯曼W. Treckmann1，
    麻仁Schulze1，
    M.的Gernot Kaiser1，
    阿里Canbay2，
    埃内斯托·Molmenti3和
    此Georgios C. Sotiropoulos1

DOI：10.1111/ liv.12766

这篇文章是受版权保护的。版权所有。

问题
第一卷。 35问题
肝国际

接受第（接受，未经编辑的文章在网上和引述的公布，最终编辑和记录排版本将出现在未来。）


作者InformationPublication历史
作者信息

    1一般，内脏及移植手术，大学医院埃森，德国
    2胃肠病学和肝病，大学医院埃森，德国
    外科3处，北岸大学医院，曼哈塞特，纽约，美国

*通讯作者联系方式：
迪特尔P.霍耶，MD
大学医院埃森
一般，内脏和移植外科
Hufelandstr。 55
45127埃森
德国
丰：004920172384002
传真：00492017231113
[email protected]

    这篇文章已被接受发表，并接受全面的同行评审，但经过审稿，排版，分页和校对过程中，这可能会导致这个版本和记录的版本之间的差异一直没有。请引用这篇文章的DOI：10.1111/ liv.12766


抽象
背景与目的

心脏骤停（CA）在死者的器官捐赠者有可能与缺血性脏器损伤有关，导致肝移植（LT）后移植功能障碍。这项研究的目的是分析心脏骤停肝供体的影响。

方法：

我们评估884连续成人患者从09/2003-12/2011进行LT在我们的机构。 UNI和多变量分析进行鉴别结果和生存预测因素从捐赠者（CA供体）和无（无CA供体）心脏骤停的历史器官。

结果

我们确定了77（8.7％），CA捐助者。平均复苏时间为16.5（1-150）分钟。从CA移植供体延长了CIT（P = 0.016），从年轻个体（P <0.001）获得，并且有较高的终端预先采购AST和ALT（P <0.001）高于无CA的捐助者。 3个月期，1年期，并为CA捐赠移植受者5年生存率为79％，76％，57％和72.1％，65.1％和53％，无CA捐赠移植（登录秩P =0.435） 。 AST峰值后LT是显著降低CA供体器官比在任何CA捐助的人（886U/ L和1321U/ L，P=0.031）。多变量分析确定CIT作为患者和移植物存活在加利福尼亚献血者的危险因素。

结论

这种分析代表肝脏捐赠者的心脏骤停的历史上最大的队列。合理的选择，这些捐助者构成一种安全的方法，以供体池的扩张。快速的分配和植入CIT的缩减可能会进一步提高，从CA捐赠肝脏的结果。

这篇文章是受版权保护的。版权所有。