心脏死亡供体经典原位肝移植的单中心临床研究

目的总结心脏死亡器官捐献（donation after cardiac death，DCD）供体供肝获取及应用于肝移植的临床经验和可行性。方法2011年11月至2012年9月，西安交通大学第一附属医院采用Maastricht标准或中国标准，共获取18例DCD供肝，于该院完成经典原位肝移植14例，送往其他移植中心3例，放弃1例。对18例供体与在该院完成肝移植的14例受体的临床资料进行回顾性分析，了解供肝情况、受体围手术期及随访结果。结果18例供体中符合Maastricht标准Ⅲ类5例、V类2例，符合中国标准Ⅲ类（即脑一心双死亡标准器官捐献，donation after brain death plus cardiac death, DBCD）11例。按规范器官获取流程取得供肝。供肝的热缺血时间为11～18min，平均为14．5min；冷缺血时间为90—600min，平均为350min。14例受体均顺利完成移植手术。其中12例受体预后良好，肝功能逐渐恢复，未出现原发性移植肝无功能、血栓形成、排斥反应，但2例出现胆道狭窄并发症，经胆道支架置人术后引流通畅；重症监护室（ICU）治疗时间平均7d，术后住院时间平均23d，病情稳定后出院。1例受体术后2d死于肝衰竭，其供体原发病为冠状动脉粥样硬化性心脏病，需给予大量多巴胺维持其血压；另1例于术后当日死于腹腔内大出血，其供体为重症哮喘、心肺复苏后死亡。12例受体者平均随访时间为6个月，总体存活率为85％，肿瘤患者尚未发现复发转移。结论DCD可以扩大供肝来源且近期效果良好，具有可行性。实施可控型DCD捐献，严格掌握供者适应证、加强器官评估、缩短热缺血时间和冷缺血时间，是保障供肝质量的重要因素。

Single-center clinical study of orthotopic liver transplantation using donation after cardiac death

Objective To summarize clinical experiences and feasibility of the acquisition of liver graft from donation after cardiac death（DCD） and its application in liver transplantation. Methods According to Maastricht Criterion or Chinese Criterion, there were totally 18 cases of DCD liver grafts procured in the First Affiliated Hospital of Xi＇an Jiaotong University from November 2011 to September 2012. Among these 18 liver grafts, 14 were transplanted in the same hospital, while three others were sent to other transplantation organizations and one was abandoned. Clinical data of 18 donors and 14 recipients, were retrospectively analyzed, including the quality of donor liver, results of recipients＇ examinations in perioperative and followed- up period. Results In 18 donors, 5 donors were in type III, 2 in type V according to Maastricht Criterion, while other 11 donors were in type III （donation after brain death plus cardiac death, DBCD） according to Chinese Criterion. Liver graft was procured according to standard technological process. The average waim ischemia time was 14. 5 min （ 11-18 min） and average cold isehemia time was 350 min （90- 600 min）. All the operations in 14 recipients were successful. Prognosis of 12 recipients was satisfactory with normal hepatic function and without liver disfunction, thrombosis and rejection. But 2 recipients developed biliary stricture and recovered after biliary stents. The average intensive care unit （ ICU ） staying time was 7 days and hospital staying time was 23 days. One recipient died of hepatic failure two days after operation, whose donor used abundant dopamine to maintain the blood pressure because of coronary atherosclerotic heart disease. And the other one died of abdominal massive bleeding on the operation day, whose donor died of severe asthma after cardio-pulmonary resuscitation. The average follow-up time in 12 recipients is 6 months. The total survival rate was 85% and no tumor recurrence was observed. Conclusions DCD is feasible for expanding the donor sources with good short term results. Controllable DCD should be carried out. To strict control donor indication, strengthen graft evaluation and shorten warm and cold ischemia time are important factors for controlling the quality of donor＇s liver graft.