公民逝世后器官捐献供肝移植31例临床效果分析

蓝柳根; 秦科; 董建辉; 黄莹; 曹嵩; 李海滨; 李壮江; 周洁惠; 孙煦勇

doi:10.3969/j.issn.1674-7445.2015.05.008

公民逝世后器官捐献供肝移植31例临床效果分析

doi: 10.3969/j.issn.1674-7445.2015.05.008

530021 南宁, 中国人民解放军第303医院移植医学研究院广西移植医学重点实验室广西移植医学工程技术研究中心广州军区器官移植中心

基金项目:

广西自然基金 2013GXNSFAA019253

广西科学技术开发与研究项目桂科攻14124003-8

详细信息

通讯作者:

Sun Xuyong,Email:sxywn@sohu.com

中图分类号: R617
计量
- 文章访问数: 75
- HTML全文浏览量: 33
- PDF下载量: 10
- 被引次数: 0
出版历程
- 收稿日期: 2015-07-28
- 网络出版日期: 2021-04-29
- 刊出日期: 2015-09-01

Clinical effect analysis of liver transplantation from donation after citizen's death in 31 cases

Institute of Transplant Medicine, the 303^rd Hospital of People's Liberation Army, Guangxi Key Laboratory for Transplantation Medicine, Guangxi Transplantation Medicine Research Center of Engineering Technology, Organ Transplantation Center of Guangzhou Military Region, 530021 Nanning, China

摘要

摘要: 目的总结公民逝世后器官捐献供肝用于肝移植的临床经验及疗效分析。方法回顾性分析2007年1月至2014年12月中国人民解放军第303医院收治的31例公民逝世后器官捐献肝移植病例的临床资料。结果 31例供体中符合中国标准Ⅰ类8例、Ⅱ类3例、Ⅲ类20例。按规范器官获取流程取得供肝。供肝的热缺血时间为2~13 min, 平均为9 min; 冷缺血时间为240~600 min, 平均为350 min。31例受体均顺利完成肝移植手术。其中29例受体恢复良好, 肝功能逐渐恢复, 未出现血栓形成、排斥反应, 4例出现胆道狭窄并发症, 经胆道支架置入术后引流通畅; 重症监护室(ICU)停留时间平均8 d, 术后住院时间平均21 d, 病情稳定后出院。受体总体存活率为81%, 1例术后2 d死于原发性肝脏无功能, 1例死于术后肺部感染, 4例肿瘤受者死于肿瘤复发转移。结论公民逝世后器官捐献可以扩大供肝来源且近期效果良好。逐渐完善捐献供体器官功能保护措施, 严格掌握供者适应证、加强器官功能评估、缩短热冷缺血时间, 是改善临床效果的重要措施。
- 公民逝世后器官捐献 /
- 脑-心双死亡标准器官捐献 /
- 肝移植 /
- 预后
Abstract: Objective To summarize the clinical experience and curative effect analysis of liver transplantation from donation after citizen's death. Methods Clinical data of 31 cases of liver transplantation from donation after citizen's death in the 303^rd Hospital of People's Liberation Army were retrospectively studied. Results Among the 31 donors, 8 donors met ClassⅠof Chinese Standard, 3 met Class Ⅱ and 20 met Class Ⅲ. The liver graft was obtained according to the standardized organ procurement process. The warm ischemia time of the liver graft was 2-13 min with the average of 9 min and the cold ischemia time was 240-600 min with the average of 350 min. Thirty-one recipients underwent the liver transplantation successfully. Twenty-nine recipients recovered well and the liver function gradually recovered without thrombosis and rejection. Four recipients developed biliary stricture and the drainage was unobstructed after biliary stent placement. The average stay time in intensive care unit (ICU) was 8 d and the average length of stay after transplantation was 21 d. The recipients were discharged when the conditions were stable. The overall survival rate of the recipients was 81%. One recipient died of primary liver dysfunction at 2 d after transplantation, one recipient died of postoperative pulmonary infection and four tumor patients died of tumor recurrence and metastasis. Conclusions Donation after citizen's death may expand the source of liver grafts and the short term effect is good. To gradually improve function protective measures for donor organs, to strictly control indications of donors, to strengthen the assessment of organ function and to shorten warm and cold ischemia time are important measures to improve clinical effect.
- Donation after citizen's death /
- Donation after brain death plus cardiac death /
- Liver transplantation /
- Prognosis

HTML全文

参考文献(18)

[1]	中华医学会器官移植学分会.中国心脏死亡器官捐献工作指南(第2版)[J].中华器官移植杂志, 2011, 32(12):756-758. http://d.wanfangdata.com.cn/Periodical/zhqgyz98201112014 Organ Transplantation Branch of Chinese medical association. Guide of donation after cardiac death in China(2nd ed)[J]. Chin J Organ Transplant, 2011, 32(12):756-758. http://d.wanfangdata.com.cn/Periodical/zhqgyz98201112014
[2]	国家卫生和计划生育委员会脑损伤质控评价中心.脑死亡判定标准与技术规范(成人质控版)[J].中华神经科杂志, 2013, 46(9):637-640. http://d.wanfangdata.com.cn/Periodical/zhsjk201309015 Brain Damage Quality Evaluation Center of National Health and Family Planning Commission. Brain death judgement standards and technical specifications (controlling the quality of adult edition)[J]. Chin J Neurol, 2013, 46(9):637-640. http://d.wanfangdata.com.cn/Periodical/zhsjk201309015
[3]	孙煦勇, 赵月涛, 文海涛, 等.腹部多器官联合切取的临床研究(附72例报告)[J].中华肝胆外科杂志, 2006, 12(5):316-318. http://www.cnki.com.cn/Article/CJFDTOTAL-ZHGD200605011.htm Sun XY, Zhao YT, Wen HT, et al. Clinical study on techniques for cadaveric total abdominal evisceration:a report of 72 cases[J]. Chin J Hepatobiliary Surg, 2006, 12(5):316-318. http://www.cnki.com.cn/Article/CJFDTOTAL-ZHGD200605011.htm
[4]	周健, 高志霞, 徐华胜, 等.乙肝疫苗免疫策略实施后的流行病学和血清学效果分析[J].中华疾病控制杂志, 2013, 17(2):170-172. http://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ201302022.htm Zhou J, Gao ZX, Xu HS, et al. Analysis on epidemiological and serum effect after the implementation of the hepatitis B vaccine strategy[J]. Chin J Dis Contr Prev, 2013, 17(2):170-172. http://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ201302022.htm
[5]	Organ Transplantation Branch of Chinese Medical Association, Section of Organ Transplantation of Surgery Branch of Chinese Medical Association, Branch of Organ Transplant Physicians of Chinese Medical Doctor Association. Expert consensus on evaluation and application of organ donated after cardiac death in China[J/CD]. Chin J Transplant:Electr Edit, 2014, 8(3):117-122. http://zhyzzz.yywkt.cn/Magazine/Show.aspx?ID=140118 中华医学会器官移植学分会, 中华医学会外科学分会移植学组, 中国医师协会器官移植医师分会等.中国心脏死亡捐献器官评估与应用专家共识[J/CD].中华移植杂志:电子版, 2014, 8(3):117-122. http://zhyzzz.yywkt.cn/Magazine/Show.aspx?ID=140118
[6]	农江, 杨建均, 何昌桓, 等.脑死亡供体肝脏病理改变及临床移植应用评估的探讨[J].热带医学杂志, 2012, 12(12):1451-1453, 封4. http://www.cnki.com.cn/Article/CJFDTOTAL-RDYZ201212012.htm Nong J, Yang JJ, He CH, et al. Pathological changes and transplantation assessments of the liver from brain-death donor[J]. J Trop Med, 2012, 12(12):1451-1453, cover 4. http://www.cnki.com.cn/Article/CJFDTOTAL-RDYZ201212012.htm
[7]	Savier E, Dondero F, Vibert E, et al. First experience of liver transplantation with type 2 donation after cardiac death in France[J]. Liver Transpl, 2015, 21(5):631-643. doi: 10.1002/lt.24107
[8]	Xia W, Ke Q, Wang Y, et al. Donation after cardiac death liver transplantation:graft quality evaluation based on pretransplant liver biopsy[J]. Liver Transpl, 2015, 21(6):838-846. doi: 10.1002/lt.v21.6
[9]	孙煦勇, 秦科, 董建辉, 等.体外膜肺氧合用于循环功能不稳定的中国一类捐赠者的器官保护三例[J].中华器官移植杂志, 2012, 33(11):657-660. http://industry.wanfangdata.com.cn/sh/Detail/Periodical?id=Periodical_zhqgyz98201211005 Sun XY, Qin K, Dong JH, et al. Organ protective effect of ECMO for donors after brain death presented with hemodynamic instability[J]. Chin J Organ Transplant, 2012, 33(11):657-660. http://industry.wanfangdata.com.cn/sh/Detail/Periodical?id=Periodical_zhqgyz98201211005
[10]	Oniscu GC, Randle LV, Muiesan P, et al. In situ normothermic regional perfusion for controlled donation after circulatory death:the United Kingdom experience[J]. Am J Transplant, 2014, 14(12):2846-2854. doi: 10.1111/ajt.12927
[11]	Hessheimer AJ, Billault C, Barrou B, et al. Hypothermic or normothermic abdominal regional perfusion in high-risk donors with extended warm ischemia times:impact on outcomes?[J]. Transpl Int, 2015, 28(6):700-707. doi: 10.1111/tri.2015.28.issue-6
[12]	Seal JB, Bohorquez H, Reichman T, et al. Thrombolytic protocol minimizes ischemic-type biliary complications in liver transplantation from donation after circulatory death donors[J]. Liver Transpl, 2015, 21(3):321-328. doi: 10.1002/lt.v21.3
[13]	Hong JC, Yersiz H, Kositamongkol P, et al. Liver transplantation using organ donation after cardiac death:a clinical predictive index for graft failure-free survival[J]. Arch Surg, 2011, 146(9):1017-1023. doi: 10.1001/archsurg.2011.240
[14]	Mourad MM, Algarni A, Liossis C, et al. Aetiology and risk factors of ischaemic cholangiopathy after liver transplantation[J]. World J Gastroenterol, 2014, 20(20):6159-6169. doi: 10.3748/wjg.v20.i20.6159
[15]	Reich DJ, Munoz SJ, Rothstein KD, et al. Controlled non-heart-beating donor liver transplantation:a successful single center experience, with topic update[J]. Transplantation, 2000, 70(8):1159-1166. doi: 10.1097/00007890-200010270-00006
[16]	Fontes P, Lopez R, van der Plaats A, et al. Liver preservation with machine perfusion and a newly developed cell-free oxygen carrier solution under subnormothermic conditions[J]. Am J Transplant, 2015, 15(2):381-394. doi: 10.1111/ajt.v15.2
[17]	Knaak JM, Spetzler VN, Goldaracena N, et al. Technique of subnormothermic ex vivo liver perfusion for the storage, assessment, and repair of marginal liver grafts[J]. J Vis Exp, 2014, (90):e51419. https://www.ncbi.nlm.nih.gov/pubmed/25145990
[18]	Jay CL, Skaro AI, Ladner DP, et al. Comparative effectiveness of donation after cardiac death versus donation after brain death liver transplantation:Recognizing who can benefit[J]. Liver Transpl, 2012, 18(6):630-640. doi: 10.1002/lt.v18.6