Luis Secanella, Felipe Alconchel, Javier López-Monclús, Enrique Toledo-Martínez, Oriana Barrios, Pablo Ramírez, Manuel Cecilio Jiménez-Garrido, Juan Carlos Rodríguez-Sanjuán, Mario Royo-Villanova, Gabriel Moreno-González, Laura Lladó
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引用次数: 0
摘要
胸腹(TA)常温区域灌注(NRP)应允许在循环死亡(cDCD)后控制捐赠的情况下同时安全恢复心脏和肝脏移植物。我们介绍了在西班牙同时获得肝脏和心脏的cDCD肝移植的初步结果,直到2021年10月。结果与来自参与机构的cDCD与腹部NRP (a -NRP)的匹配队列进行比较。主要终点包括早期同种异体移植物功能障碍(EAD)或原发性无功能(PNF),以及缺血性胆道病变(ITBL)的发展。在研究期间,使用cDCD和TA-NRP进行了6例移植。TA-NRP组的供体明显比a - nrp组年轻(中位年龄分别为45.6岁和62.9岁,p = 0.011),研究组的中位功能性热缺血时间为12.5 min,对照组为13 min。患者特征、获取时间和手术基线特征在组间无显著差异。研究组中没有患者出现EAD或PNF,在中位随访9.8个月期间,没有患者出现ITBL或移植物丢失。将A-NRP扩展到TA-NRP用于心脏获取可能在技术上具有挑战性,但既可行又安全,显示出与A-NRP相当的术后结果。
Outcomes of liver transplantation with thoracoabdominal normothermic regional perfusion: a matched-controlled initial experience in Spain
Thoracoabdominal (TA) normothermic regional perfusion (NRP) should allow the safe recovery of heart and liver grafts simultaneously in the context of controlled donation after circulatory death (cDCD). We present the initial results of cDCD liver transplantation with simultaneous liver and heart procurement in Spain until October 2021. Outcomes were compared with a matched cohort of cDCD with abdominal NRP (A-NRP) from participating institutions. Primary endpoints comprised early allograft dysfunction (EAD) or primary non-function (PNF), and the development of ischemic-type biliary lesions (ITBL). Six transplants were performed using cDCD with TA-NRP during the study period. Donors were significantly younger in the TA-NRP group than in the A-NRP group (median 45.6 years and 62.9 years respectively, p = 0.011), with a median functional warm ischemia time of 12.5 min in the study group and 13 min in the control group. Patient characteristics, procurement times, and surgical baseline characteristics did not differ significantly between groups. No patient in the study group developed EAD or PNF, and over a median follow-up of 9.8 months, none developed ITBL or graft loss. Extending A-NRP to TA-NRP for cardiac procurement may be technically challenging, but it is both feasible and safe, showing comparable postoperative outcomes to A-NRP.