Specifcation for evaluation and maintenance for donor and organ of deceased organ donation (2019 edition)
-
摘要: 为了进一步规范尸体器官捐献供体及器官评估和维护，中华医学会器官移植学分会组织器官移植专家，从供体评估、供体维护、器官功能评估与选择、器官功能维护、器官保存和运输等方面，制订本规范，以帮助器官移植工作者规范和优化尸体器官捐献供体及器官的评估和维护。
-
表 1 移植传播供体相关恶性肿瘤风险分级[5]
Table 1. Risk classification of transplantation transmission related malignant tumor from donor
风险分级 肿瘤类型 极低风险（< 0.1%传播） 皮肤基底细胞癌
皮肤鳞状细胞癌且无转移
皮肤原位癌（非黑色素瘤）
原位宫颈癌
原位声带癌
浅表（非浸润性）膀胱乳头状癌（T0N0M0期）（限于非肾移植）
孤立性甲状腺乳头状癌，≤0.5 cm
微浸润性甲状腺滤泡癌，≤1 cm
（已切除）孤立肾细胞癌，≤1 cm，分化良好（Fuhrman分级1~2级）低风险（0.1%~1.0%传播） （已切除）孤立肾细胞癌， > 1.0 cm且≤2.5 cm，分化良好（Fuhrman分级1~2级）
低级CNS肿瘤（WHO分级Ⅰ级或Ⅱ级）
原发性CNS成熟畸胎瘤
孤立性甲状腺乳头状癌，0.5~2.0 cm
微浸润性甲状腺滤泡癌，1~2 cm
经治疗的非CNS恶性肿瘤的病史（≥5年）且治愈可能性为99%中度风险（1%~10%传播） 乳腺癌（0期，即原位癌）
结肠癌（0期，即原位癌）（已切除）孤立肾细胞癌T1b（4~7 cm），分化良好（Fuhrman分级1~2级）Ⅰ期
经治疗的非CNS恶性肿瘤的病史（≥5年）且治愈可能性为90%~99%高风险（> 10%传播） 恶性黑色素瘤
乳腺癌＞0期（活动性）
结肠癌＞0期（活动性）
绒毛膜癌CNS肿瘤（任何）伴脑室腹腔或脑室-心房分流术，外科手术（非单纯活组织检查），放射治疗或CNS外转移
WHO分级Ⅲ级或Ⅳ级CNS肿瘤
白血病或淋巴瘤
黑色素瘤、白血病或淋巴瘤、小细胞肺癌或神经内分泌癌的病史
经治疗非CNS恶性肿瘤的其他病史，并包含以下任一情况：
（1）随访不足影响预估能力；（2）认为不能治愈或治愈可能性 < 90%
转移癌
肉瘤
肺癌（Ⅰ~Ⅳ期）
肾细胞癌 > 7 cm或Ⅱ~Ⅳ期
小细胞癌或神经内分泌癌，任何起源部位
其他活动性癌症WHO为世界卫生组织 
下载: 导出CSV
表 2 Remuzzi评分标准
Table 2. Evaluation standard of Remuzzi
病变 0分 1分 2分 3分 肾小球硬化比例 无硬化 ＜20% 20%~50% ＞50% 肾小管萎缩面积 无 ＜20% 20%~50% ＞50% 间质纤维化 无 ＜20% 20%~50% ＞50% 动脉和小动脉狭窄 无 管壁厚度小于管腔直径 管壁厚度等于或轻度大于管腔直径 管壁厚度远大于管腔直径 0~4分提示轻度病变，可行单肾移植；5~6分为中度病变，建议行双肾移植；7~12分为重度病变，建议弃用
下载: 导出CSV
-
[1] 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 Physicians of Chinese Medical Doctor Association. Expert consensus on donated organ function evaluation and maintenance of Chinese donatition after citizens' death(2016 edition)[J/CD]. Chin J Transplant (Electr Vers), 2016, 10(4): 145-153. DOI: 10.3877/cma.j.issn.1674-3903.2016.04.001. [2] 刘永锋, 郑树森.器官移植学[M].北京:人民卫生出版社, 2014. [3] REICH DJ, MULLIGAN DC, ABT PL, et al. ASTS recommended practice guidelines for controlled donation after cardiac death organ procurement and transplantation[J]. Am J Transplant, 2009, 9(9):2004-2011. DOI: 10.1111/j.1600-6143.2009.02739.x. [4] 中华医学会器官移植学分会, 中华预防医学会医院感染控制学分会, 复旦大学华山医院抗生素研究所.中国实体器官移植供者来源感染防控专家共识(2018版)[J].中华器官移植杂志, 2018, 39(1):41-52.DOI: 10.3760/cma.j.issn.0254-1785.2018.01.008.Branch of Organ Transplantation of Chinese Medical Association, Branch of Nosocomial Infection Control Sector of Chinese Preventive Medicine Association, Antibiotic Institute of Fudan University Huashan Hospital. Expert consensus on prevention and control of donor source infection of solid organ transplantation in China(2018 edition) [J]. Chin J Organ Transplant, 2018, 39(1):41-52. DOI: 10.3760/cma.j.issn.0254-1785.2018.01.008. [5] ZHANG S, YUAN J, LI W, et al. Organ transplantation from donors (cadaveric or living) with a history of malignancy: review of the literature[J]. Transplant Rev (Orlando), 2014, 28(4):169-175. DOI: 10.1016/j.trre.2014.06.002. [6] GELB AW, ROBERTSON KM. Anaesthetic management of the brain dead for organ donation[J]. Can J Anaesth, 1990, 37(7):806-812. doi: 10.1007/BF03006543 [7] 于凯江, 杜斌.重症医学[M].北京:人民卫生出版社, 2015. [8] 中国医院协会器官获取与分配管理工作委员会, 中国医师协会移植器官质量控制专业委员会.供体肝脏的质量控制标准(草案)[J].武汉大学学报(医学版), 2017, 38(6):954-960. http://d.old.wanfangdata.com.cn/Periodical/hubeiykdxxb201706023Organ Procurement and Allocation Administrative Committee of Chinese Hospital Association, Professional Committee for Quality Control of Transplanted Organ of Chinese Medical Doctor Association. Quality control standard of donor liver(draft) [J]. Med J Wuhan Univ, 2017, 38(6):954-960. http://d.old.wanfangdata.com.cn/Periodical/hubeiykdxxb201706023 [9] 周巍, 孔祥荣, 王凯, 等.脑死亡心脏供体的评估和管理方法探索[J/CD].实用器官移植电子杂志, 2018, 6(1): 39-44.DOI: 10.3969/j.issn.2095-5332.2018.01.010.ZHOU W, KONG XR, WANG K, et al. Evaluation and management of donor hearts from brain death[J/CD]. Pract J Organ Transplant (Electr Vers), 2018, 6(1): 39-44. DOI: 10.3969/j.issn.2095-5332.2018.01.010. [10] KILIC A, EMANI S, SAI-SUDHAKAR CB, et al. Donor selection in heart transplantation[J]. J Thorac Dis, 2014, 6(8):1097-1104. DOI: 10.3978/j.issn.2072-1439.2014.03.23. [11] COSTANZO MR, DIPCHAND A, STARLING R, et al. The International Society of Heart and Lung Transplantation guidelines for the care of heart transplant recipients[J]. J Heart Lung Transplant, 2010, 29(8):914-956. DOI: 10.1016/j.healun.2010.05.034. [12] 中华医学会器官移植学分会, 国家肺移植质量管理与控制中心.中国肺移植供体标准及获取转运指南[J].器官移植, 2018, 9(5):325-333.DOI: 10.3969/j.issn.1674-7445.2018.05.001.Branch of Organ Transplantation of Chinese Medical Association, National Quality Management and Control Center for Lung Transplantation. Guideline on the standard of lung transplantation donors and the acquisition and transshipment in China[J]. Organ Transplant, 2018, 9(5):325-333. DOI: 10.3969/j.issn.1674-7445.2018.05.001. [13] CHANEY J, SUZUKI Y, CANTU E 3RD, et al. Lung donor selection criteria[J]. J Thorac Dis, 2014, 6(8):1032-1038. DOI: 10.3978/j.issn.2072-1439.2014.03.24. [14] 毛文君, 陈静瑜.中国肺移植面临的困难及对策[J/CD].中华胸部外科电子杂志, 2016, 3(1): 1-6. DOI: 10.3877/cma.j.issn.2095-8773.2016.01.001.MAO WJ, CHEN JY. Difficulties and countermeasures of lung transplantation in China[J/CD]. Chin J Thorac Surg (Electr Edit), 2016, 3(1): 1-6. DOI: 10.3877/cma.j.issn.2095-8773.2016.01.001. [15] 石炳毅, 郑树森, 刘永锋.中国器官移植临床诊疗指南(2017版)[M].北京:人民卫生出版社, 2018. [16] BAE C, HENRY SD, GUARRERA JV. Is extracorporeal hypothermic machine perfusion of the liver better than the ' good old icebox' ?[J]. Curr Opin Organ Transplant, 2012, 17(2):137-142. DOI: 10.1097/MOT.0b013e328351083d. [17] D' AMICO F, VITALE A, GRINGERI E, et al. Liver transplantation using suboptimal grafts: impact of donor harvesting technique[J]. Liver Transpl, 2007, 13(10):1444-1450. doi: 10.1002/(ISSN)1527-6473 [18] KARAM G, COMPAGNON P, HOURMANT M, et al. A single solution for multiple organ procurement and preservation[J]. Transpl Int, 2005, 18(6):657-663. doi: 10.1111/tri.2005.18.issue-6 [19] TILLOU X, COLLON S, SURGA N, et al. Comparison of UW and Celsior: long-term results in kidney transplantation[J]. Ann Transplant, 2013, 18:146-152. DOI: 10.12659/AOT.883862. [20] NUNES P, MOTA A, FIGUEIREDO A, et al. Efficacy of renal preservation: comparative study of Celsior and University of Wisconsin solutions[J]. Transplant Proc, 2007, 39(8):2478-2479. doi: 10.1016/j.transproceed.2007.07.024 [21] STEVENS RB, SKORUPA JY, RIGLEY TH, et al. Increased primary non-function in transplanted deceased-donor kidneys flushed with histidine-tryptophan-ketoglutarate solution[J]. Am J Transplant, 2009, 9(5):1055-1062. DOI: 10.1111/j.1600-6143.2009.02624.x. [22] BARLOW AD, HOSGOOD SA, NICHOLSON ML. Current state of pancreas preservation and implications for DCD pancreas transplantation[J]. Transplantation, 2013, 95(12):1419-1424. DOI: 10.1097/TP.0b013e318285558f. [23] FRIDELL JA, MANGUS RS, POWELSON JA. Histidine-tryptophan-ketoglutarate for pancreas allograft preservation: the Indiana University experience[J]. Am J Transplant, 2010, 10(5):1284-1289. DOI: 10.1111/j.1600-6143.2010.03095.x. [24] PAUSHTER DH, QI M, DANIELSON KK, et al. Histidine-tryptophan-ketoglutarate and University of Wisconsin solution demonstrate equal effectiveness in the preservation of human pancreata intended for islet isolation: a large-scale, single-center experience[J]. Cell Transplant, 2013, 22(7):1113-1121. DOI: 10.3727/096368912X657332. [25] ERHARD J, LANGE R, SCHERER R, et al. Comparison of histidine-tryptophan-ketoglutarate (HTK) solution versus University of Wisconsin (UW) solution for organ preservation in human liver transplantation. a prospective, randomized study[J]. Transpl Int, 1994, 7(3):177-181. [26] PARSONS RF, GUARRERA JV. Preservation solutions for static cold storage of abdominal allografts: which is best? [J]. Curr Opin Organ Transplant, 2014, 19(2):100-107. DOI: 10.1097/MOT.0000000000000063. [27] HOSGOOD SA, SAEB-PARSY K, HAMED MO, et al. Successful transplantation of human kidneys deemed untransplantable but resuscitated by ex vivo normothermic machine perfusion[J]. Am J Transplant, 2016, 16(11):3282-3285. DOI: 10.1111/ajt.13906. -
下载: 
点击查看大图
表(2)
计量
- 文章访问数: 716
- HTML全文浏览量: 244
- PDF下载量: 189
- 被引次数: 0
