中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2014年
2期
86-93
,共8页
肝移植%心脏死亡器官捐献%脑死亡器官捐献%并发症%移植物存活%Meta分析%系统评价
肝移植%心髒死亡器官捐獻%腦死亡器官捐獻%併髮癥%移植物存活%Meta分析%繫統評價
간이식%심장사망기관연헌%뇌사망기관연헌%병발증%이식물존활%Meta분석%계통평개
Liver transplantation%Donation after cardiac death%Donation after brain death%Complication%Graft survival%Meta-analysis%Systematic review
目的 比较心脏死亡器官捐赠(DCD)与脑死亡器官捐赠(DBD)供肝肝移植的预后.方法 计算机检索PubMed、CENTRAL、EMbase、the ISI Web of Knowledge Databases和中国生物医学文献数据库,查找所有比较DCD和DBD供肝肝移植预后的随机对照试验、病例对照试验及回顾性队列分析,检索时限均为1990年1月至2012年1月.同时人工检索纳入文献的参考文献.按纳入排除标准由两位评价者独立进行随机对照试验的筛选、资料提取和质量评价后,采用RevMan(5.1版)软件进行荟萃分析,并采用GRADEpro软件进行证据质量评价.结果 DCD组与DBD组受者术前终末期肝病模型评分的差异无统计学意义[Z=1.37,95％可信区间(CI)(-2.25,0.26),P=0.17],DCD组较DBD组冷缺血时间短[Z=2.26,95％CI(-1.76,-0.12),P=0.02].DCD组较DBD组肝移植后胆道并发症发生率高[Z=6.37,95％CI(1.89,3.31),P＜0.000 01],血管并发症发生率高[Z=2.14,95％ CI(1.03,2.17),P=0.03],原发性移植肝无功能发生率高[Z=4.43,95％ CI(2.02,6.17),P＜0.000 01].DCD组较DBD组肝移植后1年移植物存活率低[Z=3.78,95％CI(0.84,0.94),P=0.000 2],3年移植物存活率低[Z=2.54,95％ CI(0.73,0.96),P=0.01].结果质量等级为低到中等.结论 DCD供肝肝移植后并发症发生率高于DBD供肝肝移植,DCD供肝术后1年、3年移植物存活率低于DBD供肝.DCD供肝总体较DBD供肝肝移植后的效果差.因尚无高质量的研究,临床参考时需谨慎考虑相关结果.
目的 比較心髒死亡器官捐贈(DCD)與腦死亡器官捐贈(DBD)供肝肝移植的預後.方法 計算機檢索PubMed、CENTRAL、EMbase、the ISI Web of Knowledge Databases和中國生物醫學文獻數據庫,查找所有比較DCD和DBD供肝肝移植預後的隨機對照試驗、病例對照試驗及迴顧性隊列分析,檢索時限均為1990年1月至2012年1月.同時人工檢索納入文獻的參攷文獻.按納入排除標準由兩位評價者獨立進行隨機對照試驗的篩選、資料提取和質量評價後,採用RevMan(5.1版)軟件進行薈萃分析,併採用GRADEpro軟件進行證據質量評價.結果 DCD組與DBD組受者術前終末期肝病模型評分的差異無統計學意義[Z=1.37,95％可信區間(CI)(-2.25,0.26),P=0.17],DCD組較DBD組冷缺血時間短[Z=2.26,95％CI(-1.76,-0.12),P=0.02].DCD組較DBD組肝移植後膽道併髮癥髮生率高[Z=6.37,95％CI(1.89,3.31),P＜0.000 01],血管併髮癥髮生率高[Z=2.14,95％ CI(1.03,2.17),P=0.03],原髮性移植肝無功能髮生率高[Z=4.43,95％ CI(2.02,6.17),P＜0.000 01].DCD組較DBD組肝移植後1年移植物存活率低[Z=3.78,95％CI(0.84,0.94),P=0.000 2],3年移植物存活率低[Z=2.54,95％ CI(0.73,0.96),P=0.01].結果質量等級為低到中等.結論 DCD供肝肝移植後併髮癥髮生率高于DBD供肝肝移植,DCD供肝術後1年、3年移植物存活率低于DBD供肝.DCD供肝總體較DBD供肝肝移植後的效果差.因尚無高質量的研究,臨床參攷時需謹慎攷慮相關結果.
목적 비교심장사망기관연증(DCD)여뇌사망기관연증(DBD)공간간이식적예후.방법 계산궤검색PubMed、CENTRAL、EMbase、the ISI Web of Knowledge Databases화중국생물의학문헌수거고,사조소유비교DCD화DBD공간간이식예후적수궤대조시험、병례대조시험급회고성대렬분석,검색시한균위1990년1월지2012년1월.동시인공검색납입문헌적삼고문헌.안납입배제표준유량위평개자독립진행수궤대조시험적사선、자료제취화질량평개후,채용RevMan(5.1판)연건진행회췌분석,병채용GRADEpro연건진행증거질량평개.결과 DCD조여DBD조수자술전종말기간병모형평분적차이무통계학의의[Z=1.37,95％가신구간(CI)(-2.25,0.26),P=0.17],DCD조교DBD조랭결혈시간단[Z=2.26,95％CI(-1.76,-0.12),P=0.02].DCD조교DBD조간이식후담도병발증발생솔고[Z=6.37,95％CI(1.89,3.31),P＜0.000 01],혈관병발증발생솔고[Z=2.14,95％ CI(1.03,2.17),P=0.03],원발성이식간무공능발생솔고[Z=4.43,95％ CI(2.02,6.17),P＜0.000 01].DCD조교DBD조간이식후1년이식물존활솔저[Z=3.78,95％CI(0.84,0.94),P=0.000 2],3년이식물존활솔저[Z=2.54,95％ CI(0.73,0.96),P=0.01].결과질량등급위저도중등.결론 DCD공간간이식후병발증발생솔고우DBD공간간이식,DCD공간술후1년、3년이식물존활솔저우DBD공간.DCD공간총체교DBD공간간이식후적효과차.인상무고질량적연구,림상삼고시수근신고필상관결과.
Objective To compare the outcome of donation after cardiac death (DCD) versus donation after brain death (DBD) for liver transplantation.Method Such databases as PubMed,Cochrane Central Register of Controlled Trials (CENTRAL),EMbase,the ISI Web of Knowledge databases and CBMdisk were searched from Month 1990 to March 2011 for collecting the randomized controlled trials (RCTs),case control studies and cohort analysis about DCD versus DBD for liver transplantation,and the references of those trials were also searched by hand.After study selection,assessment and data extraction conducted by two reviewers independently,meta-analyses were performed by using the RevManS.1 software.The quality of evidence was assessed by using the GRADEpro software.Result DCD group had similar MELD of recipients with DBD group before operation [Z =1.37,95％ CI(-2.25,0.26),P =0.17],and DCD group got shorter cold ischemia time than DBD group [Z=2.26,95％CI(-1.76,-0.12),P =0.02].DCD group had higher hiliary complication incidence [Z =6.37,95％ CI(1.89,3.31),P＜0.000 01],higher vascular complication incidence [Z =2.14,95％ CI(1.03,2.17),P =0.03],higher liver primary non-function (PNF) incidence [Z =4.43,95％ CI (2.02,6.17),P＜0.000 01],lower 1-year graft survival rate [Z =3.78,95％ CI(0.84,0.94),P =0.0002] and lower 3 year graft survival rate[Z=2.54,95％ CI(0.73,0.96),P =0.01] than DBD group.The quality of the result was verified from low to moderate.Conclusion Liver transplantation using DCD had higher incidence of complications and lower 1-year and 3-year graft survival rate than DBD.For the poor quality of the original studies,a prudent choice is suggested.More randomized controlled trials are needed.
