Does Time to Asystole in Donors After Circulatory Death Impact Recipient Outcome in Liver Transplantation?

IF 5.3 2区 医学 Q1 IMMUNOLOGY Transplantation Pub Date : 2024-11-01 Epub Date: 2024-05-21 DOI:10.1097/TP.0000000000005074
Abdullah K Malik, Samuel J Tingle, Chris Varghese, Ruth Owen, Balaji Mahendran, Rodrigo Figueiredo, Aimen O Amer, Ian S Currie, Steven A White, Derek M Manas, Colin H Wilson
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Abstract

Background: The agonal phase can vary following treatment withdrawal in donor after circulatory death (DCD). There is little evidence to support when procurement teams should stand down in relation to donor time to death (TTD). We assessed what impact TTD had on outcomes following DCD liver transplantation.

Methods: Data were extracted from the UK Transplant Registry on DCD liver transplant recipients from 2006 to 2021. TTD was the time from withdrawal of life-sustaining treatment to asystole, and functional warm ischemia time was the time from donor systolic blood pressure and/or oxygen saturation falling below 50 mm Hg and 70%, respectively, to aortic perfusion. The primary endpoint was 1-y graft survival. Potential predictors were fitted into Cox proportional hazards models. Adjusted restricted cubic spline models were generated to further delineate the relationship between TTD and outcome.

Results: One thousand five hundred fifty-eight recipients of a DCD liver graft were included. Median TTD in the entire cohort was 13 min (interquartile range, 9-17 min). Restricted cubic splines revealed that the risk of graft loss was significantly greater when TTD ≤14 min. After 14 min, there was no impact on graft loss. Prolonged hepatectomy time was significantly associated with graft loss (hazard ratio, 1.87; 95% confidence interval, 1.23-2.83; P  = 0.003); however, functional warm ischemia time had no impact (hazard ratio, 1.00; 95% confidence interval, 0.44-2.27; P  > 0.9).

Conclusions: A very short TTD was associated with increased risk of graft loss, possibly because of such donors being more unstable and/or experiencing brain stem death as well as circulatory death. Expanding the stand down times may increase the utilization of donor livers without significantly impairing graft outcome.

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肝脏移植中,捐献者循环死亡后出现心跳停止的时间是否会影响受者的预后?
背景:循环死亡(DCD)后的捐献者在停止治疗后的躁动期可能会有所不同。目前几乎没有证据支持采购团队应根据供体死亡时间(TTD)确定何时停止治疗。我们评估了TTD对DCD肝移植术后结果的影响:我们从英国移植登记处提取了2006年至2021年DCD肝移植受者的数据。TTD是指从停止维持生命治疗到心跳停止的时间,功能性温缺血时间是指从供体收缩压和/或氧饱和度分别低于50毫米汞柱和70%到主动脉灌注的时间。主要终点是1年移植物存活率。潜在的预测因素被纳入 Cox 比例危险模型。生成调整后的受限立方样条模型,以进一步确定TTD与结果之间的关系:结果:共纳入了 1558 例 DCD 肝脏移植受者。整个组群的TTD中位数为13分钟(四分位数间距为9-17分钟)。限制性三次样条显示,当TTD≤14分钟时,移植物丢失的风险明显增大。14 分钟后,移植物丢失没有影响。肝切除时间延长与移植物丢失显著相关(危险比,1.87;95% 置信区间,1.23-2.83;P = 0.003);然而,功能性温缺血时间没有影响(危险比,1.00;95% 置信区间,0.44-2.27;P > 0.9):极短的停机时间与移植物丢失风险增加有关,这可能是因为这类供体更不稳定和/或出现脑干死亡以及循环死亡。延长停机时间可提高供体肝脏的利用率,而不会明显影响移植结果。
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来源期刊
Transplantation
Transplantation 医学-免疫学
CiteScore
8.50
自引率
11.30%
发文量
1906
审稿时长
1 months
期刊介绍: The official journal of The Transplantation Society, and the International Liver Transplantation Society, Transplantation is published monthly and is the most cited and influential journal in the field, with more than 25,000 citations per year. Transplantation has been the trusted source for extensive and timely coverage of the most important advances in transplantation for over 50 years. The Editors and Editorial Board are an international group of research and clinical leaders that includes many pioneers of the field, representing a diverse range of areas of expertise. This capable editorial team provides thoughtful and thorough peer review, and delivers rapid, careful and insightful editorial evaluation of all manuscripts submitted to the journal. Transplantation is committed to rapid review and publication. The journal remains competitive with a time to first decision of fewer than 21 days. Transplantation was the first in the field to offer CME credit to its peer reviewers for reviews completed. The journal publishes original research articles in original clinical science and original basic science. Short reports bring attention to research at the forefront of the field. Other areas covered include cell therapy and islet transplantation, immunobiology and genomics, and xenotransplantation. ​
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