Análisis de los resultados del trasplante hepático con injertos procedentes de donación en asistolia controlada

Zusammenfassung

Objectives: The main objective of this doctoral thesis is to compare the results of liver transplantation between controlled donation after circulatory death and super-rapid recovery (type III of the modified Maastricht classification), and donation after brainstem death in our hospital. Within the group of controlled donation after circulatory death, the influence of age on the outcomes obtained with this type of donors aged over seventy years and up to eighty years was analyzed. Methodology: All liver transplants carried out with grafts from controlled donation after circulatory death between November 2014 and December 2018 at the Hospital Clínico Universitario Virgen de la Arrixaca were analyzed prospectively. The results of the controlled donation after circulatory death transplant group were compared with those of a control group that received a graft from donation after brainstem death immediately after each liver transplant with grafts from controlled donation after circulatory death. Subsequently, the results obtained within the group of liver transplants performed with donation after circulatory death, were analyzed according to the age of the donors, considering 2 subgroups with a cut-off point at 70 years of age. Results: A total of seventy-seven liver transplants with grafts from donation after circulatory death were analyzed. When comparing post-liver transplant complications between donation after circulatory death versus those in the control group ( liver transplantation with donation after brainstem death) there was no difference in the rates of primary graft dysfunction (1.3% controlled donation after circulatory death vs. 2.6% donation after brainstem death), hepatic artery thrombosis and early liver re-transplantation between the two groups. Regarding biliary complications and ischemic cholangiopathy, despite the higher percentage in the group of transplants performed with controlled donation after circulatory death, the differences were not statistically significant. After a median follow-up of 15 months, the overall survival of the grafts and recipients at one year was similar between the study group (controlled donation after circulatory death) and the control group (donation after brainstem death). When comparing the thirty-two liver transplants performed with controlled donation after circulatory death with an age greater than or equal to seventy years, with the remaining forty-five donors in controlled donation after circulatory death with an age less than seventy years, there was no difference in the rates of primary graft dysfunction, hepatic artery thrombosis, ischemic cholangiopathy, biliary complications, or retransplantation. Overall and graft survival was also similar between both subgroups. Conclusion: Overall and graft survival rates for liver transplantation with controlled donation after circulatory death and super-rapid recovery were not inferior to those obtained in a similar group of patients transplanted with grafts obtained from donation after brainstem death. However, the cost of controlled donation after circulatory death was a higher rate of biliary complications, including ischaemic cholangiopathy, but without achieving statistical significance. The age of the donor was not a negative predictor, with outcomes that were similar to other populations when transplanted with controlled donation after circulatory death of more than seventy years.