肝移植术后心脏死亡捐献肾行肾移植手术2例并文献复习

目的:加深针对扩大标准供肾的心脏死亡器官捐献(donation after cardiac death, DCD) 肾移植手术供肾质量术前评估以及术中术后管理的认识。方法:2 例供肾均来自于中南大学湘雅二医院器官移植中心同一例行肝移植手术术后5 年的供者。供者因移植肝功能恶化, 依次出现肝昏迷、脑死亡、肝肾综合征和心脏死亡。供肾评分系统(deceaseddonor score, DDS) 以及“零点”双肾肾穿刺活检被用以评估供肾功能, 综合评估后2 例受者接受了肾移植手术。结果:术后随访6 个月, 2 例受者移植肾功能基本正常。2 例受者出现肺部感染, 在给予相应治疗后出院, 未出现急性排斥反应。结论:采用肝移植术后供者DCD 肾移植手术, 术前需对供肾做出详细评估;手术后短期效果满意, 有助于扩大供体池, 远期效果有待进一步观察。

Renal transplantation with kidneys procured from cardiac deceased post-liver transplantation donor: 2 cases report and literature review

Objective: To better understand the pre-operation evaluation of donor kidneys from extended criteria donation after cardiac death and to improve the management during and after renal transplantation.
Methods: Both of the donor kidneys were from the donor who underwent liver transplantation 5 years ago in the Center of Organ Transplantation of Central South University. The donor was admitted because of liver function deterioration which led to hepatic coma, brain death, hepatorenal syndrome and cardiac death sequentially. Deceased donor score (DDS) and “zero point” kidney biopsy were applied to evaluate the donor kidney. After thorough examination of the donor and the renal function, renal transplantation was performed on 2 recipients.
Results: The recipients were followed up by 6 months, both of whom developed pulmonary infection and relieved after treatments. The kidney grafts functioned well and no surgical complication and no acute rejection occurred during the follow-up.
Conclusion: Proper evaluation of the donor organs ensures the safety of renal transplantation with kidneys from cardiac death donors who underwent liver transplantation, which is an important way to increase the number of organs for transplantation, yet the long-term effects need further observation.