Better liver transplant outcomes by donor interventions?

IF 1.8 4区 医学 Q3 TRANSPLANTATION Current Opinion in Organ Transplantation Pub Date : 2024-08-01 Epub Date: 2024-05-24 DOI:10.1097/MOT.0000000000001153
Amelia J Hessheimer, Eva Flores, Jordi Vengohechea, Constantino Fondevila
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Abstract

Purpose of review: Donor risk factors and events surrounding donation impact the quantity and quality of grafts generated to meet liver transplant waitlist demands. Donor interventions represent an opportunity to mitigate injury and risk factors within donors themselves. The purpose of this review is to describe issues to address among donation after brain death, donation after circulatory determination of death, and living donors directly, for the sake of optimizing relevant outcomes among donors and recipients.

Recent findings: Studies on donor management practices and high-level evidence supporting specific interventions are scarce. Nonetheless, for donation after brain death (DBD), critical care principles are employed to correct cardiocirculatory compromise, impaired tissue oxygenation and perfusion, and neurohormonal deficits. As well, certain treatments as well as marginally prolonging duration of brain death among otherwise stable donors may help improve posttransplant outcomes. In donation after circulatory determination of death (DCD), interventions are performed to limit warm ischemia and reverse its adverse effects. Finally, dietary and exercise programs have improved donation outcomes for both standard as well as overweight living donor (LD) candidates, while minimally invasive surgical techniques may offer improved outcomes among LD themselves.

Summary: Donor interventions represent means to improve liver transplant yield and outcomes of liver donors and grafts.

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通过捐献者干预改善肝移植效果?
审查目的:捐献者的风险因素和与捐献有关的事件会影响为满足肝移植等待者需求而产生的移植物的数量和质量。捐献者干预是减轻捐献者自身损伤和风险因素的机会。本综述旨在描述脑死亡后捐献、循环系统确定死亡后捐献以及直接活体捐献者之间需要解决的问题,以优化捐献者和受者的相关结果:有关捐献者管理实践的研究和支持具体干预措施的高级证据很少。然而,对于脑死亡(DBD)后的捐献,重症监护原则被用来纠正心循环系统受损、组织氧合和灌注受损以及神经元缺陷。此外,对病情稳定的捐献者进行某些治疗并稍微延长脑死亡持续时间,可能有助于改善移植后的预后。在循环系统确定死亡(DCD)后的捐献中,要进行干预以限制温缺血并扭转其不良影响。最后,饮食和运动计划改善了标准和超重活体供体(LD)候选者的捐献结果,而微创手术技术可能会改善LD本身的结果。
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来源期刊
CiteScore
4.10
自引率
4.50%
发文量
124
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Organ Transplantation is an indispensable resource featuring key, up-to-date and important advances in the field from around the world. Led by renowned guest editors for each section, every bimonthly issue of Current Opinion in Organ Transplantation delivers a fresh insight into topics such as stem cell transplantation, immunosuppression, tolerance induction and organ preservation and procurement. With 18 sections in total, the journal provides a convenient and thorough review of the field and will be of interest to researchers, surgeons and other healthcare professionals alike.
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