留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

公民逝世后器官捐献高龄供肝肝移植的临床疗效分析:单中心经验

谢云亮 杨洲 杨卿 冯啸 唐晖 刘炜 傅斌生 易述红 杨扬 陈规划

谢云亮, 杨洲, 杨卿, 等. 公民逝世后器官捐献高龄供肝肝移植的临床疗效分析:单中心经验[J]. 器官移植, 2020, 11(2): 271-275. doi: 10.3969/j.issn.1674-7445.2020.02.014
引用本文: 谢云亮, 杨洲, 杨卿, 等. 公民逝世后器官捐献高龄供肝肝移植的临床疗效分析:单中心经验[J]. 器官移植, 2020, 11(2): 271-275. doi: 10.3969/j.issn.1674-7445.2020.02.014
Xie Yunliang, Yang Zhou, Yang Qing, et al. Analysis of clinical effects of elderly donor liver from organ donation after citizen's death in liver transplantation: a single-center experience[J]. ORGAN TRANSPLANTATION, 2020, 11(2): 271-275. doi: 10.3969/j.issn.1674-7445.2020.02.014
Citation: Xie Yunliang, Yang Zhou, Yang Qing, et al. Analysis of clinical effects of elderly donor liver from organ donation after citizen's death in liver transplantation: a single-center experience[J]. ORGAN TRANSPLANTATION, 2020, 11(2): 271-275. doi: 10.3969/j.issn.1674-7445.2020.02.014

公民逝世后器官捐献高龄供肝肝移植的临床疗效分析:单中心经验

doi: 10.3969/j.issn.1674-7445.2020.02.014
基金项目: 

国家“十三五”重大传染病专项 2017ZX10203205

国家重点研发计划 2017YFA0104304

国家自然科学基金 81570593

国家自然科学基金 81770648

广东省自然科学基金 2015A030312013

广东省自然科学基金 2016A030313195

广东省自然科学基金 2016A030313224

广东省自然科学基金 2018A030313259

广东省科技计划项目 2017B020209004

广东省科技计划项目 20169013

广东省科技计划项目 2017B030314027

广州市科技项目 2014Y2-00200

详细信息
    作者简介:

    谢云亮,男,1995年生,硕士研究生,研究方向为肝移植,Email:XYLiang789@163.com

    通讯作者:

    傅斌生,男,1979年生,博士,副主任医师,研究方向为肝移植,Email:fubinsh@mail.sysu.edu.cn

  • 中图分类号: R617

Analysis of clinical effects of elderly donor liver from organ donation after citizen's death in liver transplantation: a single-center experience

More Information
  • 摘要:   目的  探讨高龄边缘供肝用于临床肝移植的临床疗效。  方法  根据纳入及排除标准,对127例供、受者临床资料进行回顾性分析,根据供者年龄分为高龄组(27例)和对照组(100例),对两组受者移植术后肝功能恢复情况、术后并发症发生情况及受者生存率进行分析。  结果  高龄组和对照组肝移植受者的移植物原发性无功能(PNF)和初期移植物功能不良(IPGF)发生率比较,差异均无统计学意义(均为P > 0.05)。术后2周内,高龄组肝移植受者丙氨酸转氨酶(ALT)平均水平、血清总胆红素(TB)与对照组比较,差异均无统计学意义(均为P > 0.05)。术后高龄组并发症发生情况与对照组相比,差异均无统计学意义(均为P > 0.05)。高龄组肝移植受者术后1、3年生存率分别为84%、78%,对照组分别为89%、79%,差异均无统计学意义(均为P > 0.05)。  结论  对高龄供肝应做好严格充分的质量评估和功能维护,术中精细操作、减少出血和创伤、缩短冷缺血和手术时间、加强术后监测和加速康复外科的实施,可取得良好的移植效果。

     

  • 图  1  两组受者肝移植术后生存曲线

    Figure  1.  Survival curves of recipients after liver transplantation in two groups

    表  1  两组受者术后并发症发生情况比较

    Table  1.   Comparison of postoperative complications between the two groups [n(%)]

    组别 n 排斥反应 胆道并发症 原发病复发 感染
    高龄组 27 1(3) 6(22) 4(14) 0
    对照组 100 1(1) 13(13) 15(15) 12(12)
    P 0.381 0.276 0.437 0.186
    下载: 导出CSV
  • [1] 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.1674-3903.2014.03.001.

    Branch of Organ Transplantation of Chinese Medical Association, Division of Transplantation of 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(Electr Vers), 2014, 8(3): 117-122. DOI: 10.3877/cma.j.issn.1674-3903.2014.03.001.
    [2] BUSUTTIL RW, TANAKA K. The utility of marginal donors in liver transplantation[J]. Liver Transpl, 2003, 9(7):651-663. DOI: 10.1053/jlts.2003.50105.
    [3] DE BOER JD, BLOK JJ, PUTTER H, et al. Optimizing the use of geriatric livers for transplantation in the Eurotransplant Region[J]. Liver Transpl, 2019, 25(2): 260-274. DOI: 10.1002/lt.25353.
    [4] DASARI BVM, SCHLEGEL A, MERGENTAL H, et al. The use of old donors in liver transplantation[J]. Best Pract Res Clin Gastroenterol, 2017, 31(2):211-217. DOI: 10.1016/j.bpg.2017.03.002.
    [5] JIMÉNEZ-ROMERO C, CASO MAESTRO O, CAMBRA MOLERO F, et al. Using old liver grafts for liver transplantation: where are the limits?[J].World J Gastroenterol, 2014, 20(31):10691-10702. DOI: 10.3748/wjg.v20.i31.10691.
    [6] 傅斌生, 易述红, 唐晖, 等.公民逝世后器官捐献供肝质量评估和维护的体会[J].器官移植, 2016, 7(3):215-218. DOI: 10.3969/j.issn.1674-7445.2016.03.011.

    FU BS, YI SH, TANG H, et al. Experience of quality evaluation and function maintenance of donor liver from organ donation after citizen's death[J]. Organ Transplant, 2016, 7(3):215-218. DOI: 10.3969/j.issn.1674-7445.2016.03.011.
    [7] YOUNOSSI ZM, MARCHESINI G, PINTO-CORTEZ H, et al. Epidemiology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: implications for liver transplantation[J]. Transplantation, 2019, 103(1):22-27. DOI: 10.1097/TP.0000000000002484.
    [8] ZHANG QY, ZHANG QF, ZHANG DZ. The impact of steatosis on the outcome of liver transplantation: a Meta-analysis[J]. Biomed Res Int, 2019:3962785. DOI: 10.1155/2019/3962785.
    [9] HOOFNAGLE JH, LOMBARDERO M, ZETTERMAN RK, et al. Donor age and outcome of liver transplantation[J]. Hepatology, 1996, 24(1):89-96.DOI: 10.1002/hep.510240116
    [10] FENG S, GOODRICH NP, BRAGG-GRESHAM JL, et al. Characteristics associated with liver graft failure: the concept of a donor risk index[J]. Am J Transplant, 2006, 6(4):783-790. DOI: 10.1111/j.1600-6143.2006.01242.x.
    [11] LUÉ A, SOLANAS E, BAPTISTA P, et al. How important is donor age in liver transplantation?[J]. World J Gastroenterol, 2016, 22(21):4966-4976. DOI: 10.3748/wjg.v22.i21.4966.
    [12] GILBO N, JOCHMANS I, SAINZ-BARRIGA M, et al. Age matching of elderly liver grafts with elderly recipients does not have a synergistic effect on long-term outcomes when both are carefully selected[J]. Transplant Direct, 2019, 5(4):e342. DOI: 10.1097/TXD.0000000000000883.
    [13] GHINOLFI D, LAI Q, PEZZATI D, et al. Use of elderly donors in liver transplantation: a paired-match analysis at a single center[J]. Ann Surg, 2018, 268(2):325-331. DOI: 10.1097/SLA.0000000000002305.
    [14] CROOME KP, MATHUR AK, LEE DD, et al. Outcomes of donation after circulatory death liver grafts from donors 50 years or older: a multicenter analysis[J]. Transplantation, 2018, 102(7):1108-1114. DOI: 10.1097/TP.0000000000002120.
    [15] ROULLET S, DEFAYE M, QUINART A, et al. Liver transplantation with old grafts: a ten-year experience[J]. Transplant Proc, 2017, 49(9):2135-2143. DOI: 10.1016/j.transproceed.2017.07.012.
    [16] CASO-MAESTRO O, JIMÉNEZ-ROMERO C, JUSTO-ALONSO I, et al. Analyzing predictors of graft survival in patients undergoing liver transplantation with donors aged 70 years and over[J]. World J Gastroenterol, 2018, 24(47):5391-5402. DOI: 10.3748/wjg.v24.i47.5391.
    [17] SEGEV DL, MALEY WR, SIMPKINS CE, et al. Minimizing risk associated with elderly liver donors by matching to preferred recipients[J]. Hepatology, 2007, 46(6):1907-1918.DOI: 10.1002/hep.21888.
    [18] BYRD KK, MEHAL JM, SCHILLIE SF, et al. Chronic liver disease-associated hospitalizations among adults with diabetes, national inpatient sample, 2001-2012[J]. Public Health Rep, 2015, 130(6):693-703.DOI: 10.1177/003335491513000619.
    [19] BRÜGGENWIRTH IMA, DOLGIN NH, PORTE RJ, et al. Donor diabetes and prolonged cold ischemia time synergistically increase the risk of graft failure after liver transplantation[J]. Transplant Direct, 2017, 3(7):e173. DOI: 10.1097/TXD.0000000000000692.
    [20] RAMOS-PROL A, HERVÁS-MARÍN D, GARCÍA-CASTELL A, et al. Outcomes in patients with diabetes 10 years after liver transplantation[J]. J Diabetes, 2017, 9(11):1033-1039. DOI: 10.1111/1753-0407.12520.
    [21] GHINOLFI D, DE SIMONE P, LAI Q, et al. Risk analysis of ischemic-type biliary lesions after liver transplant using octogenarian donors[J]. Liver Transpl, 2016, 22(5):588-598. DOI: 10.1002/lt.24401.
    [22] AYAR Y, ERSOY A, OCAKOGLU G, et al. Risk factors affecting graft and patient survivals after transplantation from deceased donors in a developing country: a single-center experience[J]. Transplant Proc, 2017, 49(2):270-277. DOI: 10.1016/j.transproceed.2016.12.009.
    [23] BITTERMANN T, GOLDBERG DS. Quantifying the effect of transplanting older donor livers into younger recipients: the need for donor-recipient age matching[J]. Transplantation, 2018, 102(12):2033-2037. DOI: 10.1097/TP.0000000000002341.
    [24] GOLDARACENA N, SAPISOCHIN G, SPETZLER V, et al. Live donor liver transplantation with older (≥50 years) versus younger (< 50 years) donors: does age matter?[J]. Ann Surg, 2016, 263(5):979-985. DOI: 10.1097/SLA.0000000000001337.
    [25] BIAN S, ZHU Z, SUN L, et al. Normothermic machine perfusion versus cold storage of liver in pig model: a Meta-analysis[J]. Ann Transplant, 2018, 23:197-206. DOI: 10.12659/AOT.908774.
    [26] TCHILIKIDI KY. Liver graft preservation methods during cold ischemia phase and normothermic machine perfusion[J]. World J Gastrointest Surg, 2019, 11(3):126-142. DOI: 10.4240/wjgs.v11.i3.126.
    [27] BOTEON YL, ATTARD J, BOTEON APCS, et al. Manipulation of lipid metabolism during normothermic machine perfusion: effect of defatting therapies on donor liver functional recovery[J]. Liver Transpl, 2019, 25(7):1007-1022. DOI: 10.1002/lt.25439.
    [28] GHINOLFI D, RREKA E, DE TATA V, et al. Pilot, open, randomized, prospective trial for normothermic machine perfusion evaluation in liver transplantation from older donors[J]. Liver Transpl, 2019, 25(3):436-449. DOI: 10.1002/lt.25362.
    [29] VAN LEEUWEN OB, DE VRIES Y, FUJIYOSHI M, et al. Transplantation of high-risk donor livers after ex situ resuscitation and assessment using combined hypo- and normothermic machine perfusion[J].Ann Surg, 2019, 270(5):906-914. DOI: 10.1097/sla.0000000000003540.
    [30] RULL R, VIDAL O, MOMBLAN D, et al. Evaluation of potential liver donors: limits imposed by donor variables in liver transplantation[J]. Liver Transpl, 2003, 9(4):389-393.DOI: 10.1053/jlts.2003.50050.
  • 加载中
图(1) / 表(1)
计量
  • 文章访问数:  60
  • HTML全文浏览量:  56
  • PDF下载量:  9
  • 被引次数: 0
出版历程
  • 收稿日期:  2019-12-06
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2020-03-15

目录

    /

    返回文章
    返回