PDF(Pubmed)
Abstract：
Machine perfusion (MP) has been shown worldwide to offer many advantages in liver transplantation, but it still has some gray areas. The purpose of the study is to evaluate the donor risk factors of grafts, perfused with any MP, that might predict an ineffective MP setting and those would trigger post-transplant early allograft dysfunction (EAD). Data from donors of all MP-perfused grafts at six liver transplant centers have been analyzed, whether implanted or discarded after perfusion. The first endpoint was the negative events after perfusion (NegE), which is the number of grafts discarded plus those that were implanted but lost after the transplant. A risk factor analysis for NegE was performed and marginal grafts for MP were identified. Finally, the risk of EAD was analyzed, considering only implanted grafts. From 2015 to September 2019, 158 grafts were perfused with MP: 151 grafts were implanted and 7 were discarded after the MP phase because they did not reach viability criteria. Of 151, 15 grafts were lost after transplant, so the NegE group consisted of 22 donors. In univariate analysis, the donor risk index >1.7, the presence of hypertension in the medical history, static cold ischemia time, and the moderate or severe macrovesicular steatosis were the significant factors for NegE. Multivariate analysis confirmed that macrosteatosis >30% was an independent risk factor for NegE (odd ratio 5.643, p = 0.023, 95% confidence interval, 1.27-24.98). Of 151 transplanted patients, 34% experienced EAD and had worse 1- and 3-year-survival, compared with those who did not face EAD (NoEAD), 96% and 96% for EAD vs. 89% and 71% for NoEAD, respectively (p = 0.03). None of the donor/graft characteristics was associated with EAD even if the graft was moderately steatotic or fibrotic or from an aged donor. For the first time, this study shows that macrovesicular steatosis >30% might be a warning factor involved in the risk of graft loss or a cause of graft discard after the MP treatment. On the other hand, the MP seems to be useful in reducing the donor and graft weight in the development of EAD.
摘要：
机器灌注（MP）已在全球范围内证明在肝移植中具有许多优势，但它仍然有一些灰色地带。该研究的目的是评估移植物的供体风险因素，灌注任何MP，这可能会预测无效的MP设置，并且会引发移植后早期同种异体移植功能障碍（EAD）。分析了来自六个肝移植中心的所有MP灌注移植物的供体的数据，灌注后是否植入或丢弃。第一个终点是灌注后的阴性事件（NegE），即丢弃的移植物数量加上移植后被植入但丢失的移植物数量。进行了NegE的危险因素分析，并确定了MP的边缘移植物。最后,分析了EAD的风险，只考虑植入移植物。从2015年到2019年9月，158个移植物被灌注MP：151个移植物被植入，7个在MP期后被丢弃，因为它们没有达到生存能力标准。在151个移植物中，有15个移植物在移植后丢失，所以NegE组由22个捐赠者组成。在单变量分析中，供体风险指数>1.7，病史中存在高血压，静态冷缺血时间，中度或重度大泡性脂肪变性是NegE的重要因素。多因素分析证实,>30%的大脂肪变性是NegE的独立危险因素(奇数比5.643,p=0.023,95%置信区间,1.27-24.98)。在151名移植患者中，34%经历了EAD，1年和3年生存率较差，与那些没有面对EAD（NoEAD）的人相比，96%和96%的EAD与89%和71%的NoEAD，分别（p=0.03）。即使移植物是中度脂肪变性或纤维化的或来自衰老的供体，供体/移植物的特征均与EAD无关。第一次,这项研究表明,>30%的大泡性脂肪变性可能是MP治疗后移植物丢失或移植物丢弃风险的一个警告因素.另一方面,MP似乎有助于减少EAD发展中的供体和移植物重量。
