A randomized-controlled trial of ischemia-free liver transplantation for end-stage liver disease

作者：Zhiyong Guo, Qiang Zhao, Zehua Jia, Changjun Huang, Dongping Wang, Weiqiang Ju, Jian Zhang, Lu Yang, Shanzhou� Huang, Maogen Chen, Xiaofeng Zhu, Anbin Hu, Yi Ma, Linwei Wu, Yinghua Chen, Ming Han, Yunhua Tang, Guodong Wang, Linhe Wang, Lifen Li, Wei Xiong, Zhiheng Zhang, Yuekun Shen, Zhaoxia Tang, Caihui Zhu, Xiaoxiang Chen, Xiaoguang Hu, Yiwen Guo, Honghui Chen, Yihao Ma, Tao Zhang, Shunwei Huang, Ping Zeng, Simei Lai, Tielong Wang, Zhitao Chen, Jinlong Gong, Yu Jia, Canhui Sun, Chang Li, Haiyi Tan, Yao Liu, Yuqi Dong, Chengjun Sun, Bing Liao, Jun Ren, Zhenhai Zhou, Andrea Schlegel, Nashan Björn, Chang-jie Cai, Fengqiu Gong, Jian Rong, Wenqi Huang, Xiangdong Guan, Pierre‐Alain Clavien, Tullius G. Stefan, Jiefu Huang, Xiaoshun He · 发表于：Journal of Hepatology · 年份：2023 · DOI：10.1016/j.jhep.2023.04.010 · 被引用次数：125 · 研究领域：Organ Transplantation Techniques and Outcomes、Liver Disease and Transplantation、Abdominal vascular conditions and treatments

BACKGROUND & AIMS: Ischemia-reperfusion injury (IRI) has thus far been considered as an inevitable component of organ transplantation, compromising outcomes, and limiting organ availability. Ischemia-free organ transplantation is a novel approach designed to avoid IRI, with the potential to improve outcomes. METHODS: In this randomized-controlled clinical trial, recipients of livers from donors after brain death were randomly assigned to receive either an ischemia-free or a 'conventional' transplant. The primary endpoint was the incidence of early allograft dysfunction. Secondary endpoints included complications related to graft IRI. RESULTS: Out of 68 randomized patients, 65 underwent transplants and were included in the analysis. 32 patients received ischemia-free liver transplantation (IFLT), and 33 received conventional liver transplantation (CLT). Early allograft dysfunction occurred in two recipients (6%) randomized to IFLT and in eight (24%) randomized to CLT (difference -18%; 95% CI -35% to -1%; p = 0.044). Post-reperfusion syndrome occurred in three recipients (9%) randomized to IFLT and in 21 (64%) randomized to CLT (difference -54%; 95% CI -74% to -35%; p <0.001). Non-anastomotic biliary strictures diagnosed with protocol magnetic resonance cholangiopancreatography at 12 months were observed in two recipients (8%) randomized to IFLT and in nine (36%) randomized to CLT (difference, -28%; 95% CI -50% to -7%; p = 0.014). The comprehensive complication index at 1 year ...