Modern-Day Practice of DCD Liver Transplantation: Controversies, Innovations, and Future Directions.

Q1 Medicine Current Gastroenterology Reports Pub Date : 2023-12-01 Epub Date: 2023-10-28 DOI:10.1007/s11894-023-00902-8

Omar J Haque, Eve M Roth, David D Lee

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Abstract

Purpose of review: Over the past decade, donation after circulatory death (DCD) liver transplantation has expanded in the United States due to improved surgical experience and perioperative management. Despite these advances, there remains a reluctance towards broader utilization of DCD liver allografts due to lack of standardized donation process, concern for inferior graft survival, and risk of ischemic cholangiopathy associated with temporary lack of oxygenated perfusion during withdrawal of life-supporting treatment during procurement.

Recent findings: New perfusion technologies offer potential therapeutic options to mitigate biliary complications and expand utilization of marginal DCD grafts. As these modalities enter routine clinical practice, DCD utilization will continue to increase, and liver allocation policies in turn will evolve to reflect this growing practice. This review describes recent progress in DCD LT, current challenges with utilization of DCD liver allografts, and how novel technologies and policies could impact the future of the field.

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DCD肝移植的现代实践：争议、创新和未来方向。

综述目的：在过去的十年里，由于手术经验和围手术期管理的改善，循环死亡（DCD）肝移植后的捐赠在美国有所扩大。尽管取得了这些进展，但由于缺乏标准化的捐赠流程、对移植物存活率低下的担忧以及在采购期间停止生命支持治疗期间暂时缺乏充氧灌注导致缺血性胆管病的风险，DCD肝同种异体移植物仍不愿更广泛地使用。最近的发现：新的灌注技术为减轻胆道并发症和扩大边缘DCD移植物的利用提供了潜在的治疗选择。随着这些模式进入常规临床实践，DCD的利用率将继续增加，肝脏分配政策也将随之演变，以反映这种不断增长的实践。这篇综述描述了DCD LT的最新进展，DCD同种异体肝移植物利用的当前挑战，以及新技术和政策如何影响该领域的未来。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Current Gastroenterology Reports Medicine-Gastroenterology

CiteScore

7.80

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0.00%

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期刊介绍： As the field of gastroenterology and hepatology rapidly evolves, the wealth of published literature can be overwhelming. The aim of the journal is to help readers stay abreast of such advances by offering authoritative, systematic reviews by leading experts. We accomplish this aim by appointing Section Editors who invite international experts to contribute review articles that highlight recent developments and important papers published in the past year. Major topics in gastroenterology are covered, including pediatric gastroenterology, neuromuscular disorders, infections, nutrition, and inflammatory bowel disease. These reviews provide clear, insightful summaries of expert perspectives relevant to clinical practice. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. We also provide commentaries from well-known figures in the field.

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