公民逝世后器官捐献供肝移植62例临床分析

目的分析公民逝世后器官捐献供肝移植的流程方法及疗效,为公民逝世后器官捐献供肝移植提供一定借鉴。 方法回顾性分析中山大学附属中山医院2008年10月至2015年12月完成62例公民逝世后器官捐献肝移植病例的临床资料。 结果62例均符合《中国心脏死亡器官捐献工作指南》三类捐献标准（脑-心双死亡标准器官捐献,DBCD）。所有病例按标准成功完成了肝脏捐献及获取流程,其中15例使用体外膜肺氧合技术（ECMO）维持至器官获取。供肝热缺血时间0~30（16.2±6.5）min,冷缺血时间190~680（347±39）min。62例受体均顺利植入供肝,未出现原发性移植肝无功能、排斥反应。1例围手术期死于多发动脉血栓形成,1例发生胆漏经引流后自愈,2例发生胆道狭窄并发症,经胆道支架置入后缓解;肿瘤复发转移死亡3例。 结论通过合理流程充分利用ECMO,加强获取器官管理,缩短热冷缺血时间,公民逝世后器官捐献供肝移植可以获得较满意的临床效果。

Clinical analysis of 62 cases of liver transplantation from donation after citizen death

ObjectiveTo provide evidence for the liver transplantation from donation after citizen death by analyzing the procedure and effect of liver transplantation from donation after citizen's death. MethodsThe receptors' clinical data, donor maintenance, organ procurement, the recptors' perioperative and prognosis of sixty-two recipients undergoing liver transplantation from donation after citizen's death were retrospectively analyzed from Oct 2008 to Dec 2015 in Zhongshan Hospital affiliated to Sun Yat-sen University. ResultsAll the 62 cases were conformed to meet the standard of donation after brain death plus cardiac death (DBCD). Liver graft and harvesting was procured according to technological process standard, including 15 donors treated with extracoporeal membrane oxygenation (ECMO). The warm ischemia time of donation was 0-30 (16.2±6.5) min, and the cold time of donation was 190-680 (347±39) min. All recipients were successfully implanted the donor liver, with no primary malfunction or rejection. 1 recipient died of multiple arterial thrombosis in perioperative period, and 3 from tumor recurrence and metastasis. 3 recipients suffered from biliary complication, including 1 bile leakage recovering after drainage, 2 biliary stricture relieving after stenting biliary stent. ConclusionLiver transplantation from donation after citizen death can be clinically satisfactory with making reasonable procedure of ECMO, reinforcing the management of organ procurement, and reducing the warm and cold ischemic time.