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Donation after cardio-circulatory death liver transplantation

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The renewed interest in donation after cardio-circulatory death (DCD) started in the 1990s following the limited success of the transplant community to expand the donation after brain-death (DBD) organ supply and following the request of potential DCD families.Since then,DCD organ procurement and transplantation activities have rapidly expanded,particularly for nonvital organs,like kidneys.In liver transplantation (LT),DCD donors are a valuable organ source that helps to decrease the mortality rate on the waiting lists and to increase the availability of organs for transplantation despite a higher risk of early graft dysfunction,more frequent vascular and ischemia-type biliary lesions,higher rates of re-listing and re-transplantation and lower graft survival,which are obviously due to the inevitable warm ischemia occurring during the declaration of death and organ retrieval process.Experimental strategies intervening in both donors and recipients at different phases of the transplantation process have focused on the attenuation of ischemia-reperfusion injury and already gained encouraging results,and some of them have found their way from pre-clinical success into clinical reality.The future of DCD-LT is promising.Concerted efforts should concentrate on the identification of suitable donors (probably Maastricht category Ⅲ DCD donors),better donor and recipient matching (high risk donors to low risk recipients),use of advanced organ preservation techniques (oxygenated hypothermic machine perfusion,normothermic machine perfusion,venous systemic oxygen persufflation),and pharmacological modulation (probably a multi-factorial biologic modulation strategy) so that DCD liver allografts could be safely utilized and attain equivalent results as DBD-LT.

Non-heart-beating donationComplicationBile ductAllocationIschemiaIschemia-reperfusion injuryLiver disease

Hieu Le Dinh、Arnaud de Roover、Abdour Kaba、Séverine Lauwick、Jean Joris、Jean Delwaide、Pierre Honoré

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Department of Abdominal Surgery and Transplantation, University Hospital of Liège, University of Liège, 4000 Liège, Belgium

Department of Anesthesia and Intensive Care Medicine, University Hospital of Liège, University of Liège, 4000 Liège, Belgium

Department of Hepatology and Gastroenterology, University Hospital of Liège, University of Liège, 4000 Liège, Belgium

2012

10.3748/wjg.v18.i33.4491

世界胃肠病学杂志(英文版)
太原消化病研治中心

世界胃肠病学杂志(英文版)

SCI
影响因子：1.001
ISSN：1007-9327
年,卷(期)：2012.18(33)
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