臨床外科75巻9号

2020年09月発行

特集 変貌する肝移植—適応拡大・ドナー選択・治療戦略の最先端を知る 生体・脳死ドナーにおける新展開

脳死肝移植における拡大基準ドナー—諸外国の最近の動向とわが国の現状

著者： 竹村裕介¹ 篠田昌宏¹² 阿部雄太¹ 大島剛¹ 堀周太郎¹ 松原健太郎¹ 八木洋¹ 北郷実¹ 尾原秀明¹ 北川雄光¹

所属機関： ¹慶應義塾大学医学部外科 ²国際医療福祉大学三田病院消化器センター

ページ範囲：P.1036 - P.1041

【ポイント】
◆拡大基準ドナーは移植後臓器機能不全，疾患伝播のリスクが高いドナーの総称であるが，その項目は国や地域により異なる．
◆近年欧米からの報告により，拡大基準ドナーを用いていても，その他のリスクを最小限にすることで比較的良好なレシピエント成績を得ることができることが明らかになってきた．
◆本邦からの知見は少ないが，本邦独自のドナー評価基準を作成するために現在全国規模で臨床研究が進行中である．

参考文献

1）日本肝移植学会：肝移植症例登録報告．移植54：81-96，2019

2）Vodkin I, Kuo A：Extended criteria donors in liver transplantation. Clin Liver Dis 21：289-301, 2017

3）Feng S, Goodrich NP, Bragg-Gresham JL, et al：Characteristics associated with liver graft failure：the concept of a donor risk index. Am J Transplant 6：783-790, 2006

4）Durand F, Renz JF, Alkofer B, et al：Report of the Paris consensus meeting on expanded criteria donors in liver transplantation. Liver Transpl 14：1694-1707, 2008

5）Braat AE, Blok JJ, Putter H, et al：The Eurotransplant donor risk index in liver transplantation：ET-DRI. Am J Transplant 12：2789-2796, 2012

6）Winter A, Feray C, Audureau E, et al：External validation of the Donor Risk Index and the Eurotransplant Donor Risk Index on the French liver transplantation registry. Liver Int 37：1229-1238, 2017

7）Collett D, Friend PJ, Watson CJ：Factors associated with short- and long-term liver graft survival in the United Kingdom：development of a UK Donor Liver Index. Transplantation 101：786-792, 2017

8）Winter A, Feray C, Audureau E, et al：A Donor Quality Index for liver transplantation：development, internal and external validation. Sci Rep 8：9871, 2018

9）Dutkowski P, Oberkofler CE, Slankamenac K, et al：Are there better guidelines for allocation in liver transplantation? A novel score targeting justice and utility in the model for end-stage liver disease era. Ann Surg 254：745-753, 2011

10）Rana A, Hardy MA, Halazun KJ, et al：Survival outcomes following liver transplantation（SOFT）score：a novel method to predict patient survival following liver transplantation. Am J Transplant 8：2537-2546, 2008

11）Furukawa H, Taniguchi M, Fujiyoshi M, et al：Japanese Study Group of Liver Transplantation：Experience using extended criteria donors in first 100 cases of deceased donor liver transplantation in Japan. Transplant Proc 44：373-375, 2012

12）Ghinolfi D, Marti J, De Simone P, et al：Use of octogenarian donors for liver transplantation：a survival analysis. Am J Transplant 14：2062-2071, 2014

13）Kim DY, Moon J, Island ER, et al：Liver transplantation using elderly donors：a risk factor analysis. Clin Transplant 25：270-276, 2011

14）Broomhead RH, Patel S, Fernando B, et al：Resource implications of expanding the use of donation after circulatory determination of death in liver transplantation. Liver Transpl 18：771-778, 2012

15）Mangus RS, Schroering JR, Fridell JA, et al：Impact of Donor Pre-Procurement Cardiac Arrest（PPCA）on clinical outcomes in liver transplantation. Ann Transplant 23：808-814, 2018

16）Hoyer DP, Paul A, Saner F, et al：Safely expanding the donor pool：brain dead donors with history of temporary cardiac arrest. Liver Int 35：1756-1763, 2015

17）Elaffandi AH, Bonney GK, Gunson B, et al：Increasing the donor pool：consideration of prehospital cardiac arrest in controlled donation after circulatory death for liver transplantation. Liver Transpl 20：63-71, 2014

18）Linares I, Hamar M, Selzner N, et al：Steatosis in liver transplantation：current limitations and future strategies. Transplantation 103：78-90, 2019

19）Chavin KD, Taber DJ, Norcross M, et al：Safe use of highly steatotic livers by utilizing a donor/recipient clinical algorithm. Clin Transplant 27：732-741, 2013

20）Wong TCL, Fung JYY, Chok KSH, et al：Excellent outcomes of liver transplantation using severely steatotic grafts from brain-dead donors. Liver Transpl 22：226-236, 2016

21）Melin C, Miick R, Young NA, et al：Approach to intraoperative consultation for donor liver biopsies. Arch Pathol Lab Med 137：270-274, 2013

22）Ishak K, Baptista A, Bianchi L, et al：Histological grading and staging of chronic hepatitis. J Hepatol 22：696-699, 1995

23）Flechtenmacher C, Schirmacher P, Schemmer P：Donor liver histology：a valuable tool in graft selection. Langenbecks Arch Surg 400：551-557, 2015

24）Wadhera V, Harimoto N, Lubezky N, et al：The impact of donor liver allograft fibrosis on patients undergoing liver transplantation. Clin Transplant 32：e13187, 2018

25）Lo IJ, Lefkowitch JH, Feirt N, et al：Utility of liver allograft biopsy obtained at procurement. Liver Transpl 14：639-646, 2008

26）日本移植学会・脳死分割肝移植推進委員会（編）：脳死分割肝移植ガイドライン，2018.〔http://jlts.umin.ac.jp/images/20180223guide_text.pdf〕

27）Sakamoto S, Kasahara M, Ogura Y, et al；Japanese Liver Transplantation Society：Current status of deceased donor split liver transplantation in Japan. J Hepatobiliary Pancreat Sci 22：837-845, 2015

28）Silberhumer GR, Rahmel A, Karam V, et al：The difficulty in defining extended donor criteria for liver grafts：the Eurotransplant experience. Transpl Int 26：990-998, 2013

29）Dutkowski P, Guarrera JV, de Jonge J, et al：Evolving trends in machine perfusion for liver transplantation. Gastroenterology 156：1542-1547, 2019

30）Yu S, Yu J, Zhang W, et al：Safe use of liver grafts from hepatitis B surface antigen positive donors in liver transplantation. J Hepatol 61：809-815, 2014

31）Crismale JF, Ahmad J：Expanding the donor pool：Hepatitis C, hepatitis B and human immunodeficiency virus-positive donors in liver transplantation. World J Gastroenterol 25：6799-6812, 2019

32）Ballarin R, Cucchetti A, Spaggiari M, et al：Long-term follow-up and outcome of liver transplantation from anti-hepatitis C virus-positive donors：a European multicentric case-control study. Transplantation 91：1265-1272, 2011

33）Lai JC, O'Leary JG, Trotter JF, et al：Risk of advanced fibrosis with grafts from hepatitis C antibody-positive donors：a multicenter cohort study. Liver Transpl 18：532-538, 2012

34）Suehiro T, Shimada M, Kishikawa K, et al：Prevention of hepatitis B virus infection from hepatitis B core antibody-positive donor graft using hepatitis B immune globulin and lamivudine in living donor liver transplantation. Liver Int 25：1169-1174, 2005

35）Dickson RC, Everhart JE, Lake JR, et al：Transmission of hepatitis B by transplantation of livers from donors positive for antibody to hepatitis B core antigen. The National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database. Gastroenterology 113：1668-1674, 1997

36）Uemoto S, Sugiyama K, Marusawa H, et al：Transmission of Hepatitis B virus from Hepatitis B core antibody-positive donors in living related liver transplants. Transplantation 65：494-499, 1998

37）Angelico M, Nardi A, Marianelli T, et al：Hepatitis B-core antibody positive donors in liver transplantation and their impact on graft survival：evidence from the Liver Match cohort study. J Hepatol 58：715-723, 2013

38）Myron KH, McBride MA, Cherikh WS, et al：Transplant tumor registry：donor related malignancies. Transplantation 74：358-362, 2002

39）Desai R, Collett D, Watson CJ, et al：Cancer transmission from organ donors-unavoidable but low risk. Transplantation 94：1200-1207, 2012

40）Feng S, Buell JF, Chari RS, et al：Tumors and transplantation：The 2003 Third Annual ASTS State-of-the-Art Winter Symposium. Am J Transpl 3：1481-1487, 2003

41）篠田昌宏，竹村裕介，尾原秀明，他：わが国独自の脳死肝移植ドナー受諾新基準策定を目指して〜自施設経験とJOT情報解析結果〜．第55回日本移植学会総会，2019，広島