脑-心双死亡供肝与尸体供肝移植安全性比较

目的 探讨脑-心双死亡（donation after brain plus cardiac death，DBCD）供肝肝移植手术安全性及近期疗效。方法 收集本科肝移植相关资料：供肝热缺血时间（warm ischemic time，WIT）、冷缺血时间（cold ischemic time，CIT）、手术时间、受体无肝期时间，术后第1、3、7天肝功能变化（ALT、TBIL），及术后早期各种并发症发生率等。按供肝来源不同分为DBCD组（观察组）与尸体供肝组（对照组），比较两组相关资料的差异及与术后肝功能和并发症的关系。冷/热缺血时间和早期肝功能受损程度相关性分析采用Pearson检验。结果 与对照组相比，DBCD组热缺血时间较长[（9.5±2.2）min vs （4.9±1.5）min，t =10.719，P ＜0.001]，冷缺血时间较短[（4.7±0.9）h vs （7.2±2.2）h，t =8.008，P ＜0.001]。术后第1、3天肝功能ALT和TBIL，DBCD组较对照组增高明显[（1 294.3±181.7）IU/L vs （641.3±41.0）IU/L，P =0.001；（497.4±56.4）IU/L vs （308.6±15.9）IU/L，P =0.003]。术后第7 天两组肝功能变化差异不大（P ＞0.05）。两组术后早期并发症率和手术死亡率比较无统计学意义差异（P＞0.05）。DBCD组数据显示热缺血时间长短与移植术后1周内ALT峰值呈正相关（r 2=0.826，P ＜0.001）。结论 DBCD组冷缺血时间较尸体供肝组缩短，但热缺血时间较尸体供肝组延长，总体在安全范围内且可控性良好，因此DBCD肝移植是安全的。

Safety comparison of donation after brain plus cardiac death versus cadaveric donor in liver transplantion

Objective To evaluate the safety and the therapentic effects of liver transplantation by using the donation after brain plus cardiac death (DBCD). Methods The data related to liver transplantation with DBCD donor liver (experimental group) was collected, including the donor warm ischemia time (WIT), the cold ischemia time (CIT), operation time, anhepatic phase of receptor, the change of liver function (ALT and TBIL) at d1, d3 and d7 after operation, and the early postoperative complications. The cadaveric donor liver was used as the control group. The difference of data between experimental group and control group was compared. The WIT, CIT and extent of liver function impairment analysis was performed using Pearson correlation test; when P<0.05 was considered statistically significant. Results Compared with the control group, the experimental group showed longer WIT [(9.5±2.2) min vs (4.9±1.5) min, t=10.719, P<0.001], and shorter CIT [(4.7±0.9) h vs (7.2±2.2) h, t=8.008, P<0.001]; The experimental group indicated higher ALT at d1 (1 294.3±181.7 IU/L vs 641.3±41.0 IU/L, P=0.001) and d3 (497.4±56.4 IU/L vs 308.6±15.9 IU/L, P=0.003). However, no statistically significant difference of ALT at d7 was observed between the experimental group and the control group (P>0.05). The WIT and the peak value of ALT in one week after liver transplantation of the experimental group were significantly correlated (r2=0.826, P<0.001). In addition there was no statistically significant difference between the experimental group and the control group for the early postoperative complication rate. Conclusion The experimental group has longer WIT than the control group which is related to the extent of the postoperative injury of liver function. However, the experimental group indicates shorter CIT than the control group. Applications ofDBCD liver after rigorous assessment is safe.