2013综述 DCD LT(肝移植)

GUIDELINESFORCLINICALPRACTICEDonationaftercardio-circulatorydeathlivertransplantationHieuLeDinh,ArnauddeRoover,AbdourKaba,SéverineLauwick,JeanJoris,JeanDelwaide,PierreHonoré,MichelMeurisse,OlivierDetryHieuLeDinh,ArnauddeRoover,PierreHonoré,MichelMeurisse,OlivierDetry,DepartmentofAbdominalSurgeryandTransplantation,UniversityHospitalofLiège,UniversityofLiège,4000Liège,BelgiumAbdourKaba,SéverineLauwick,JeanJoris,DepartmentofAnesthesiaandIntensiveCareMedicine,UniversityHospitalofLiège,UniversityofLiège,4000Liège,BelgiumJeanDelwaide,DepartmentofHepatologyandGastroenterol-ogy,UniversityHospitalofLiège,UniversityofLiège,4000Liège,BelgiumAuthorcontributions:LeDinhHperformedtheliteraturere-viewandwrotethemanuscript;deRooverA,KabaA,LauwickS,JorisJ,DelwaideJ,HonoréPandMeurisseMconstitutetheteaminvolvedinthecareofthelivertransplantpatientsandtheyreviewedandcommentedthemanuscript;DetryOsuper-visedthereview.Correspondenceto:OlivierDetry,Professor,DepartmentofAbdominalSurgeryandTransplantation,UniversityHospitalofLiège,UniversityofLiège,SartTilmanB35,4000Liège,[e-mail]:[phone]Fax:[phone]Received:December9,2011Revised:March27,2012Accepted:March29,2012Publishedonline:September7,2012AbstractTherenewedinterestindonationaftercardio-circu-latorydeath(DCD)startedinthe1990sfollowingthelimitedsuccessofthetransplantcommunitytoexpandthedonationafterbrain-death(DBD)organsupplyandfollowingtherequestofpotentialDCDfamilies.Sincethen,DCDorganprocurementandtransplantationactivitieshaverapidlyexpanded,particularlyfornon-vitalorgans,likekidneys.Inlivertransplantation(LT),DCDdonorsareavaluableorgansourcethathelpstodecreasethemortalityrateonthewaitinglistsandtoincreasetheavailabilityoforgansfortransplantationdespiteahigherriskofearlygraftdysfunction,morefrequentvascularandischemia-typebiliarylesions,higherratesofre-listingandre-transplantationandlowergraftsurvival,whichareobviouslyduetotheinevitablewarmischemiaoccurringduringthedeclara-tionofdeathandorganretrievalprocess.Experimentalstrategiesinterveninginbothdonorsandrecipientsatdifferentphasesofthetransplantationprocesshavefocusedontheattenuationofischemia-reperfusionin-juryandalreadygainedencouragingresults,andsomeofthemhavefoundtheirwayfrompre-clinicalsuccessintoclinicalreality.ThefutureofDCD-LTispromising.Concertedeffortsshouldconcentrateontheidentifica-tionofsuitabledonors(probablyMaastrichtcategoryⅢDCDdonors),betterdonorandrecipientmatching(highriskdonorstolowriskrecipients),useofad-vancedorganpreservationtechniques(oxygenatedhy-pothermicmachineperfusion,normothermicmachineperfusion,venoussystemicoxygenpersufflation),andpharmacologicalmodulation(probablyamulti-factorialbiologicmodulationstrategy)sothatDCDliveral-lograftscouldbesafelyutilizedandattainequivalentresultsasDBD-LT.©2012Baishideng.Allrightsreserved.Keywords:Non-heart-beatingdonation;Complication;Bileduct;Allocation;Ischemia;Ischemia-reperfusioninjury;LiverdiseasePeerreviewers:BijanEghtesad,AssociateProfessor,Depart-mentofGeneralSurgery,ClevelandClinicFoundation,9500EuclidAvenue,Cleveland,OH44195,UnitedStates;TokihikoSawada,AssociateProfessor,SecondDepartmentofSurgery,DokkyoUniversitySchoolofMedicine,Kitakobayashi880,Mibu,Shimotsuga,Tochigi321-0293,Japan;PhilipRosenthal,Professor,Pediatrics,UCSF,500parnassusAvenue,SanFrancisco,CA94143-0136,UnitedStatesLeDinhH,deRooverA,KabaA,LauwickS,JorisJ,DelwaideJ,HonoréP,MeurisseM,DetryO.Donationaftercardio-circu-latorydeathlivertransplantation.WorldJGastroenterol2012;18(33):4491-4506Availablefrom:URL::(33):4491-4506ISSN1007-9327(print)ISSN2219-2840(online)©2012Baishideng.Allrightsreserved.OnlineSubmissions:@wjgnet.comdoi:10.3748/wjg.v18.i33.44914491September7,2012|Volume18|Issue33|WJG|(LT)wereper-formedfromdonationaftercardio-circulatorydeath(DCD)inthe1960s[1-4].DCD-LTwasnonethelessalmostuniversallyabandonedinthefollowingtwodecades,giventhewell-recognizedHarvardbrain-deadconceptin1968andgiventhebetterresultsofLToriginatingfromdonationafterbraindeath(DBD)[5].In1983,LTwasap-provedasatherapeuticmodalityforend-stageliverdis-easesafteralongperiodconsideredasanexperimentalprocedure.TherenewedinterestinDCDdonorsstartedinthe1990sfollowingthelimitedsuccessofthetrans-plantcommunitytoexpandtheDBDorgansupplyandfollowingtherequestofpotentialDCDfamilies.IfDCDkidneysareincreasinglyacceptedaroundtheworld[6],theuseofDCDliversremainslimitedinexpe-riencedtransplantcentersduetohigherrisksofprimarygraftdysfunctionandbiliarycomplicationsaswellasalackofareliableviabilitytestingpriortoliverimplanta-tion.HoweverthenumberofDCD-LTincreasedrapidlyoverthepastdecade.IntheUnitedStates,276DCDliv-ertransplantswereperformedin2008comparedtoonly23casesin1999,makingup5%ofthedeceaseddonor(DD)livertransplants[7-10].Thesametrendwa