公民逝世后器官捐献供肝保护及功能评估临床分析

丁利民; 徐志丹; 李新长; 罗文峰; 龙成美; 罗来邦

doi:10.3969/j.issn.1674-7445.2017.06.004

公民逝世后器官捐献供肝保护及功能评估临床分析

doi: 10.3969/j.issn.1674-7445.2017.06.004

330006 南昌，江西省人民医院器官移植科

基金项目:

江西省卫计委科技计划 20155012

详细信息

通讯作者:
徐志丹, Email: xuzhidan1970@163.com

中图分类号: R617
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出版历程
- 收稿日期: 2017-07-31
- 网络出版日期: 2021-01-19
- 刊出日期: 2017-11-15

Clinical analysis on donor liver protection and function evaluation for organ donation after citizen's death

Department of Organ Transplantation, Jiangxi Provincial People's Hospital, Nanchang 330006, China

More Information

Corresponding author: Xu Zhidan, Email: xuzhidan1970@163.com

摘要

摘要: 目的总结公民逝世后器官捐献供肝保护及功能评估的初步经验。方法回顾性分析35例公民逝世后器官捐献供者和33例受者的临床资料。总结供肝获取情况和受者预后情况；根据供者器官获取前的血清钠离子水平（血清钠），将相应受者分为血清钠＜155 mmol/L组、血清钠155~160 mmol/L组和血清钠161~180 mmol/L组，比较3组受者术后早期移植肝功能不全的发生率。结果 35例供者中，中国标准二类27例，中国标准三类8例，实施肝移植33例，余2例肝脏有淤血性肝硬化改变，弃用。33例肝移植受者中，30例恢复顺利，术后7~14 d肝功能逐渐恢复正常，长期门诊随访移植肝功能基本正常；3例受者死亡，其中2例死于门静脉血栓形成，1例死于肺部感染合并多器官功能衰竭。血清钠＜155 mmol/L组、血清钠155~160 mmol/L组和血清钠161~180 mmol/L组受者术后早期移植肝功能不全的发生率依次为18%、23%和4/5，其中，血清钠161~180 mmol/L组明显高于血清钠＜155 mmol/L组（P＜0.05）。结论对公民逝世后器官捐献供肝功能进行及时、准确的评估和维护是提高供肝利用率、保证供肝功能和取得较好移植效果的关键因素。
- 公民逝世后器官捐献 /
- 供肝保护 /
- 功能评估 /
- 肝移植 /
- 高钠血症 /
- 移植肝功能不全 /
- 并发症 /
- 门静脉血栓
Abstract: Objective To summarize the preliminary experience of donor liver protection and function evaluation for organ donation after citizen's death. Methods Clinical data of 35 donors from organ donation after citizen's death and 33 recipients were retrospectively analyzed. Donor liver procurement and clinical prognosis of the recipients were summarized. According to serum level of sodium ion (serum sodium) before organ procurement, all recipients were divided into the serum sodium < 155 mmol/L, 155-160 mmol/L and 161-180 mmol/L groups. The incidence of liver graft dysfunction early after liver transplantation was statistically compared among three groups. Results In 35 donors, 27 cases were Chinese type Ⅱ and 8 cases were Chinese type Ⅲ. Thirty-three donor livers were used for liver transplantation, and the remaining 2 cases of donor livers were excluded due to congestive cirrhosis. In 33 liver transplantation recipients, 30 cases were successfully recovered. The liver function was gradually restored at postoperative 7-14 d, and normal liver function was obtained during long-term follow-up. Postoperatively, 3 recipients died including 2 cases dying from portal vein thrombosis and 1 case from pulmonary infection complicated with multiple organ failure. The incidence of early liver graft dysfunction of the recipients after liver transplantation was 18%, 23% and 4/5 in the serum sodium < 155 mmol/L, 155-160 mmol/Land 161-180 mmol/L groups, respectively. Statistical significance was observed between the 161-180 mmol/L and < 155 mmol/L groups (P < 0.05). Conclusions Timely protection of donor liver, accurate evaluation and maintenance of liver function play a pivotal role in enhancing the utilization rate of donor liver, maintaining liver function and yielding good efficacy for transplantation.
- Organ donation after citizen's death /
- Donor liver protection /
- Function evaluation /
- Liver transplantation /
- Hypernatremia /
- Liver graft dysfunction /
- Complication /
- Portal vein thrombosis

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参考文献(16)

[1]	霍枫.公民心脏死亡器官捐献开启我国器官移植新时代[J].器官移植, 2013, 4(5): 247-249. DOI: 10.3969/j.issn.1674-7445.2013.05.001. Huo F. New time of organ transplantation started by donation after cardiac death of citizens in China[J]. Organ Transplant, 2013, 4(5): 247-249. DOI: 10.3969/j.issn.1674-7445.2013.05.001.
[2]	Chamorro C, Falcón JA, Michelena JC. Controversial points in organ donor management[J]. Transplant Proc, 2009, 41(8):3473-3475. DOI: 10.1016/j.transproceed.2009.09.004.
[3]	王光策, 王锁刚, 张翥, 等.脑死亡器官捐献移植过程中的问题[J].中国组织工程研究与临床康复, 2011, 15(18): 3280-3283. DOI: 10.3969/j.issn.1673-8225. 2011.18.013. Wang GC, Wang SG, Zhang Z, et al. Several problems in brain-dead donor kidney transplantation[J]. J Clin Rehabil Tissue Eng Res, 2011, 15(18): 3280-3283. DOI: 10.3969/j.issn.1673-8225. 2011.18.013.
[4]	López-Navidad A, Caballero F, Guirado L, et a1. The medical-nursing team specialized in the maintenance of the brain-dead heart-beating organ donor exclusively dedicated to caring for the donor reduces donor loss from asystolia to zero[J]. Transplant Proc, 2002, 34(1): 20-22. doi: 10.1016/S0041-1345(01)02826-3
[5]	Desai CJ. Selection and maintenance of a cadaver donor for liver transplantation[J]. Apollo Med, 2012, 9(1): 9-16. doi: 10.1016/S0976-0016(12)60114-8
[6]	王钢, 周洪澜, 王伟刚, 等. 心脏死亡器官捐献供体维护的体会[J/CD]. 实用器官移植电子杂志, 2013, 1(5): 282-285. DOI: 10.3969/j.issn.2095-5332.2013.05.003. Wang G, Zhou HL, Wang WG, et al. The experience for maintenance of cardiac death organ donation[J/CD]. Pract J Organ Transplant (Elect Vers), 2013, 1(5): 282-285. DOI: 10.3969/j.issn.2095-5332.2013.05.003.
[7]	杨顺良, 谭建明.潜在脑死亡捐献者的器官维护[J].器官移植, 2015, 6(5): 288-293. DOI: 10.3969/j.issn.1674-7445.2015.05.002. Yang SL, Tan JM. Organ maintenance of potential brain death donors[J]. Organ Transplant, 2015, 6(5): 288-293. DOI: 10.3969/j.issn.1674-7445.2015.05.002.
[8]	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. 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. DOI: 10.3877/cma.j.issn.1647-3903.2014.03.001. Branch of Organ Transplantation of Chinese Medical Association, Transplantation Group in Branch of Surgery of Chinese Medical Association, Branch of Organ Transplant Physician of Chinese Medical Doctor Association. Expert consensus on evaluation and application of organ donated after cardiac death in China[J/CD]. Chin J Transplant (Elect Vers), 2014, 8(3): 117-122. DOI: 10.3877/cma.j.issn.1647-3903.2014.03.001.
[9]	魏来, 张波, 陈知水.中国移植器官保护专家共识(2016版)解读[J].临床外科杂志, 2017, 25(1): 26-29. DOI: 10.3969/j.issn.1005-6483.2017.01.006. Wei L, Zhang B, Chen ZS. Interpretation for the expert consensus on the protection of transplant organ in China (2016)[J]. J Clin Surg, 2017, 25(1): 26-29. DOI: 10.3969/j.issn.1005-6483.2017.01.006.
[10]	中华医学会器官移植学分会, 中国医师协会器官移植医师分会. 中国公民逝世后捐献供器官功能评估和维护专家共识(2016版)[J/CD]. 中华移植杂志(电子版), 2016, 10(4): 145-153. DOI: 10.3877/cma.j.issn.1674-3903.2016.04.001. Branch of Organ Transplantation of Chinese Medical Association, Branch of Organ Transplant Physician of Chinese Medical Doctor Association. Expert consensus on evaluation and maintenance of organ donated after citizens death in China (2016)[J/CD]. Chin J Transplant (Elect Vers), 2016, 10(4): 145-153. DOI: 10.3877/cma.j.issn.1674-3903.2016.04.001.
[11]	李晓璟, 叶啟发, 明英姿, 等.心脏死亡供肝肝移植疗效进展[J].中华医学杂志, 2016, 96(8): 666-668. DOI: 10.3760/cma.j.issn.0376-2491.2016.08.021. Li XJ, Ye QF, Ming YZ, et al. Advance on the the therapeutic effect of liver transplantation from donation after cardiac death[J]. Natl Med J China, 2016, 96(8): 666-668. DOI: 10.3760/cma.j.issn.0376-2491.2016.08.021.
[12]	Mathur AK, Heimbach J, Steffick DE, et a1. Donation after cardiac death liver transplantation: predictors of outcome[J]. Am J Transplant, 2010, 10(11): 2512-2519. DOI: 10.1111/j.1600-6143.2010.03293.x.
[13]	Karp SJ, Johnson S, Evenson A, et a1. Minimising cold ischaemic time is essential in cardiac death donor-associated liver transplantation[J]. HPB (Oxford), 2011, 13(6): 411-416.DOI: 10.1111/j.1477-2574.2011.00307.x.
[14]	王泽惠, 王永进, 侯云生, 等.心肺复苏后多器官功能障碍综合征临床分析[J].中国急救医学, 2005, 25(8): 609-610.DOI: 10.3969/j.issn.1002-1949.2005. 08.027. Wang ZH, Wang YJ, Hou YS, et al. Clinical analysis of multiple organ dysfunction syndrome after cardiopulmonary resuscitation[J]. Chin J Crit Care Med, 2005, 25(8): 609-610. DOI: 10.3969/j.issn.1002-1949.2005. 08.027.
[15]	Totsuka E, Dodson F, Urakami A, et al. Influence of high donor serum sodium levels on early postoperative graft function in human liver transplantation: effect of correction of donor hypernatremia[J]. Liver Transpl Surg, 1999, 5(5): 421-428. DOI: 10.1002/lt.500050510.
[16]	时军, 罗文峰, 丁利民, 等.脑死亡儿童供肝成人移植临床分析[J].中华肝胆外科杂志, 2011, 17(5): 359-363. DOI: 10.3760/cma.j.issn.1007-8118.2011.05.004. Shi J, Luo WF, Ding LM, et al. Clinical analysis of liver transplant from a child of brain death to an adult[J]. Chin J Hepatobiliary Surg, 2011, 17(5): 359-363. DOI: 10.3760/cma.j.issn.1007-8118.2011.05.004.