供体贫血对肝移植术后结果的影响:冷缺血时间分层分析

David Uihwan Lee , Mohammed Rifat Shaik , Kuntal Bhowmick , Youngjae Cha , Ki Jung Lee , Nishat Anjum Shaik , Gregory Hongyuan Fan , Miranda Tsang , Eddie Kwon , Hannah Chou , Harrison Chou , Raza Malik
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引用次数: 0

摘要

背景,缺血时间(CIT)长期以来一直与肝移植(LT)移植物存活有关。供体贫血导致肝脏供氧不足,理论上可能会加重CIT相关的缺血再灌注损伤。在本研究中,我们对CIT进行了分类,并通过不同的供体红细胞压积(Hct)阈值来研究供体贫血、CIT和lt受体预后之间的潜在关系。方法采用联合器官共享网络(UNOS)标准移植分析与研究(STAR)数据库对2005 - 2019年肝移植患者进行研究。根据供体Hct阈值<;27.6, 27.6-32.3和>;32.3,并在所有CIT和设定阈值之间进行比较。评估的主要结果是全因死亡率和移植物衰竭。所有的研究结果都是与供体Hct低于27.6的肝移植受体进行比较。在包含所有CIT阈值的复合人群中,肝移植受者的全因死亡率更高(aHR 1.04;95% CI 1.00-1.08, p=0.05),以及移植物衰竭(aHR 1.10;95% CI 1.01-1.20, p=0.02),供体Hct高于32.3。在第一个CIT组中,主要结局没有显著差异。第二CIT组的受者Hct高于32.3时移植物失败率更高(aHR 1.17;95% CI 1.01-1.37, p=0.04)。供体Hct高于32.3的受者全因死亡率较高(aHR 1.07;95% CI 1.00-1.14, p=0.04)。结论与中度至重度供体贫血相比,正常供体Hct和轻度供体贫血与较差的受体结果相关。这可能潜在地代表供体移植物从慢性贫血或多因素的局部适应,组织为基础的过程。这些关联值得进一步调查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The impact of donor anemia on post-liver transplant outcomes: A stratified analysis by cold ischemia time

Background & Aims

Cold ischemia time (CIT) has long been correlated with liver transplant (LT) graft viability. Donor anemia, leading to suboptimal oxygen delivery to the liver, may theoretically worsen the ischemia-reperfusion injury associated with CIT. In this study, we stratify CIT by tertiles and investigate the potential relationship between donor anemia, CIT, and LT-recipient prognosis by varying donor hematocrit (Hct) thresholds.

Methods

The United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research (STAR) Database was used to study LT patients between 2005 and 2019. Patients were categorized into tertiles by donor Hct thresholds of < 27.6, 27.6-32.3, and > 32.3, and compared amongst all CIT and set thresholds. Primary outcomes assessed were all-cause mortality and graft failure.

Results

All study results are reported in comparison to LT recipients with donor Hct below 27.6. In the composite population encompassing all CIT thresholds, LT recipients experienced higher all-cause mortality (aHR 1.04; 95% CI 1.00-1.08, p=0.05), as well as graft failure (aHR 1.10; 95% CI 1.01-1.20, p=0.02) with donor Hct above 32.3. There were no significant differences in primary outcomes within the first CIT tertile. Recipients within the 2nd CIT tertile experienced higher rates of graft failure with Hct above 32.3 (aHR 1.17; 95% CI 1.01-1.37, p=0.04). Higher all-cause mortality was observed in recipients with donor Hct above 32.3 (aHR 1.07; 95% CI 1.00-1.14, p=0.04) within the 3rd tertile of CIT.

Conclusion

Normal donor Hct and mild donor anemia were associated with worse LT-recipient outcomes when compared to moderate-to-severe donor anemia. This may potentially represent a local adaptation in the donor graft from chronic anemia or a multifactorial, organization-based process. These associations warrant further investigation.
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