Chinese expert consensus on organ protection of transplantation (2022 edition)

doi:10.3877/cma.j.issn.1674-0793.2022.04.001

Abstract

Abstract:

Organ transplantation is the most effective treatment for end-stage organ failure, and voluntary donation after citizen’s death is the only source of transplant organ in China. Clinically, transplant organ protection technique plays a critical role in improving the quality of transplant organs and the prognosis of recipients. On the basis of domestic and worldwide basic research and clinical practice of transplant organ protection and according to the Oxford evidence classification and GRADE system, the experts organized by Branch of Organ Transplant Physicians of Chinese Medical Doctor Association, Branch of Transplantation Group of Surgery of Chinese Medical Association and China Liver Transplant Registry Scientific Committee had compiled and published the Chinese Expert Consensus on Organ Protection of Transplantation (2016 edition) for liver, kidney, pancreas, small intestine, heart, lung transplant organs. With the support of China Liver Transplant Registry, National Trauma Medical Center, National Quality Control Center for Human Donated Organ Procurement, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation and National Center for Healthcare Quality Management in Liver Transplant combined with recent domeatic and worldwide clinical practice and research progress for organ transplantation and organ protection, the Chinese Expert Consensus on Organ Protection of Transplantation (2022 edition) has been published recently. This consensus focuses on updating the technical progress and evidence-based medicine of organ procurement, preservation, transport, and quality evaluation in clinical practice. Additionally, the content of composite tissue transplantation mainly including limb transplantation has also been covered. The aim is to promote the the scientific and standardized clinical organ transplantation.

Key words: Organ transplantation, Organ preservation, Machine perfusion, Organ preservation solution, Static cold storage, Donation after brain death, Donation after cardiac death, Expanded criteria donor

China Liver Transplant Registry, National Center for Healthcare Quality Management in Liver Transplant, National Quality Control Center for Human Donated Organ Procurement, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Committee on Transplant Organ Quality Control, Branch of Organ Transplant Physicians of Chinese Medical Doctor Association, Organ Procurement and Allocation Working Committee of the China Hospital Association, National Trauma Medical Center Organ Protection Committee. Chinese expert consensus on organ protection of transplantation (2022 edition)[J]. Chinese Archives of General Surgery(Electronic Edition), 2022, 16(04): 241-254.

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证据级别	定义
Ⅰ	同质RCT的系统评价
	单个RCT（可信区间窄）
	全或无病案系列研究
Ⅱ	同质队列研究的系统评价
	单个队列研究（包括低质量RCT，如随访率<80%）
	结果研究，生态学研究
Ⅲ	同质病例对照研究的系统评价
	单个病例对照研究
Ⅳ	病例系列研究（包括低质量队列及病例对照研究）
Ⅴ	基于经验未严格论证的专家意见

证据级别	定义
Ⅰ	同质RCT的系统评价
	单个RCT（可信区间窄）
	全或无病案系列研究
Ⅱ	同质队列研究的系统评价
	单个队列研究（包括低质量RCT，如随访率<80%）
	结果研究，生态学研究
Ⅲ	同质病例对照研究的系统评价
	单个病例对照研究
Ⅳ	病例系列研究（包括低质量队列及病例对照研究）
Ⅴ	基于经验未严格论证的专家意见

序号	建议	证据级别	推荐强度
1	腹部器官获取及保存过程中应尽量缩短冷缺血和热缺血时间	Ⅱ	强
2	目前供肝保存以SCS为主	Ⅱ	强
3	UW液和HTK液是目前供肝保存最常用的保存液，二者保存效果接近	Ⅱ	强
4	HOPE可减少DCD供肝肝移植术后非吻合性胆道并发症发生	Ⅰ	强
5	NMP可促进肝移植术后肝功能恢复、改善移植预后	Ⅰ	强
6	机械灌注可在供肝保存修复及转运过程中动态监测、评价供肝质量	Ⅱ	强

序号	建议	证据级别	推荐强度
1	腹部器官获取及保存过程中应尽量缩短冷缺血和热缺血时间	Ⅱ	强
2	目前供肝保存以SCS为主	Ⅱ	强
3	UW液和HTK液是目前供肝保存最常用的保存液，二者保存效果接近	Ⅱ	强
4	HOPE可减少DCD供肝肝移植术后非吻合性胆道并发症发生	Ⅰ	强
5	NMP可促进肝移植术后肝功能恢复、改善移植预后	Ⅰ	强
6	机械灌注可在供肝保存修复及转运过程中动态监测、评价供肝质量	Ⅱ	强

序号	建议	证据级别	推荐强度
1	UW液、HTK液、Marshall液、Celsior液、HC-A Ⅱ液以及IGL-1液对供肾SCS具有良好的效果	Ⅱ	强
2	过长的冷缺血时间与肾移植术后不良预后密切相关，已经经历了热缺血的供肾，应缩短供肾冷保存时间	Ⅱ	强
3	HMP显著降低肾移植术后DGF发生率，并有助于改善移植物存活率	Ⅰ	强
4	KPS-1液应用于HMP对供肾具有较好的保护效果	Ⅲ	强
5	超长冷缺血时间仍是HMP保存供肾发生DGF的独立危险因素，应适当控制HMP保存时间	Ⅲ	强
6	肾移植术前NMP能显著改善冷保存ECD或DCD供肾质量、降低术后DGF发生率	Ⅳ	弱

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