双低温氧合机灌注肝脏可减少移植后胆道并发症--一项回顾性队列研究。

IF 12.5 2区 医学 Q1 SURGERY
David Pereyra, Jule Dingfelder, Moriz Riha, Sertac Kacar, Laurin Rauter, Nikolaus Becker, Tina Saffarian Zadeh, Chiara Tortopis, Patrick Starlinger, Robin Ristl, Gerd Silberhumer, Andreas Salat, Thomas Soliman, Gabriela Berlakovich, Georg Gyoeri
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引用次数: 0

摘要

背景:有确凿证据表明,在正位肝移植(OLT)前使用低温氧合机灌注(HOPE)对胆道并发症有好处。在此,我们旨在评估与使用静态冷藏(SCS)相比,通过门静脉单独灌注(sHOPE)或通过肝动脉额外灌注(dHOPE)是否会对 OLT 后的结果产生不同影响:对维也纳医科大学接受OLT的连续患者(2018年至2023年)进行了回顾性分析。供体器官使用 SCS 获取,或进行末端缺血 sHOPE 或 dHOPE。胆道并发症的严重程度根据治疗干预程度(内镜逆行胰胆管造影术或手术修补术)进行分类。接受 HOPE 治疗的患者住院时间更短(中位天数:SCS=25 vs HOPE=20,P=0.019)。接受 HOPE 治疗的患者胆道并发症发生率较低(SCS=37.7% vs HOPE=22.5%,P=0.015)。据观察,HOPE队列中因胆道并发症而进行手术翻修的发生率明显较低(24.6% vs 11.8%,P=0.012)。在根据 HOPE 方式评估结果时,与 SCS 相比,只有 dHOPE 患者的胆道并发症(P=0.006)和手术翻修(P=0.002)显著减少。此外,在单变量和多变量逻辑回归中,只有dHOPE与胆道并发症手术翻修需求的减少有明显相关性(几率比=0.336,P=0.011):结论:HOPE可减少胆道并发症和相关的手术翻修。结论:HOPE可减少胆道并发症和相关的手术翻修,这种效果似乎主要与使用dHOPE有关,而这两种方法似乎都是在OLT前对供体移植物进行预处理的可行方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Dual hypothermic oxygenated machine perfusion of the liver reduces post transplant biliary complications - a retrospective cohort study.

Background: Corroborating evidence for use of hypothermic oxygenated machine perfusion (HOPE) prior to orthotopic liver transplantation (OLT) suggests a beneficial effect in regards to biliary complications. Here, we aim to evaluate whether perfusion via portal vein alone (sHOPE) or via additional perfusion of the hepatic artery (dHOPE) have diverging impact on outcomes after OLT when compared to use of static cold storage (SCS).

Methods: Consecutive patients undergoing OLT at Medical University of Vienna (2018 to 2023) were retrospectively analyzed. Donor organs were procured using SCS, or subjected to end-ischemic sHOPE or dHOPE. Severity of biliary complications was classified according to degree of therapeutic intervention (endoscopic retrograde cholangiopancreatography or surgical revision).

Results: 247 patients were included (69 SCS, 76 sHOPE, 102 dHOPE). Hospitalization was shorter for patients after HOPE (median in days: SCS=25 vs HOPE=20, P=0.019). Biliary complications were less frequent in patients after HOPE (SCS=37.7% vs HOPE=22.5%, P=0.015). A significantly lower incidence of surgical revisions for biliary complications was observed in the HOPE cohort (24.6% vs 11.8%, P=0.012). When evaluating outcome according to HOPE-modality, a significant reduction in biliary complications (P=0.006) and surgical revisions (P=0.002) was only observed in dHOPE patients in comparison to SCS. Further, only dHOPE was significantly associated with reduced need for surgical revision for biliary complications upon uni- and multivariable logistic regression (odds ratio=0.336, P=0.011).

Conclusion: HOPE leads to a reduction of biliary complications and associated surgical revisions. This effect seems to be primarily associated with use of dHOPE, while both methods appear as feasible options for preconditioning of donor grafts prior to OLT.

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来源期刊
CiteScore
17.70
自引率
3.30%
发文量
0
审稿时长
6-12 weeks
期刊介绍: The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.
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