扩大标准的供体肝脏在成人间肝脏移植中的应用  

Application of extended criteria donor graft in adult cadaveric liver transplant

作　　者：王营 曲明 史艳芬 杜英东 尹惠生 刘延军 张成钧 

机构地区：[1]解放军一零七中心医院肝胆外科,山东省烟台264002

出　　处：《中华普通外科杂志》2013年第3期196-199,共4页Chinese Journal of General Surgery

摘　　要：目的探讨不同扩大标准的供体肝脏在成人肝脏移植中的应用经验。方法我院自2003年1月至2009年6月共施行肝脏移植126例，其中接受标准供体肝移植74例，接受了扩大标准供体52例。根据所含风险因素的不同，将扩大标准的供体分为E1组（含1～2个风险因素）35例、E2组（含3个以上风险因素）17例。与接受标准供体的74例患者相比较，分析52例接受扩大标准供体的受体的临床资料及生存情况。结果同标准供体组相比较接受扩大标准供体组受体术后半年和1年生存率差异无统计学意义（分别χ2=2．55，3．64，均P〉0．05）。但接受标准供体组受体2年生存率优于接受扩大标准供体组受体（χ2=4．9，P〈0．05）。同标准供体组相比，接受E1组扩大标准供体组受体术后半年、1年和2年生存率差异无统计学意义（分别χ2=0．85，0．45，0．23，均P〉0．05）。E2组受体术后半年、1年和2年生存率均低于接受标准供体肝脏的受体（分别χ2=3．91，8．67，11．34，均P〈0．05）。MELD评分〈20的患者接受E2组供体术后半年、1年和2年生存率与MELD评分〉20的患者接受E1组供体，差异有统计学意义（分别）（χ2=0．16，0．16，0．07，均P〈0．05）。供肝冷缺血时间〉12h是影响受体生存率的独立危险因素。结论在所含风险因素较少的情况下，扩大标准的供体肝脏或者MELD评分〈20的受体是可以应用的。Objective To evaluate extended criteria donor liver in adult eadaverie liver transplant. Methods 126 liver transplantations were performed from January 2003 to June 2009, of them, 74 patients received standard criteria donor livers, 52 patients received extended criteria donor livers. These 52 donor livers could be divided into two groups ： E1 group （ a graft with 1 to 2 risk factors） and E2 group（ a graft with 3 to 4 risk factors）. Results There was no significant difference in half a year and 1 year survival rates between patients received E1 group extended criteria donor livers and those received standard criteria donor livers（respectivelyχ2 = 2.55, 3.64, all P 〉 0. 05 ）. But 2 year survival rate of patients received E1 group extended criteria donor livers was lower than those receiving standard criteria donor livers （ χ2 = 4. 9, P 〈 0. 05）. Half a year, 1 year and 2 year survival rates in patients receiving E2 group extended criteria donor livers were less than those receiving standard criteria donor livers （respectively χ2 = 3.91,8.67,11.34, all P 〈 0. 05 ）. The half a year, 1 year, and 2 year survival rates of patients received extended criteria donor livers with MELD score more than 20 was less than those with MELD score 〈 20 （respectivelyχ2 = 0. 16, 0. 16,0. 07, all P 〈 0. 05 ）. Conclusions Extended criteria donor livers can be used safely if the risk factor of donor liver was less than 3, or when recipient＇s MELD score was 〈 20.

关 键 词：肝移植 危险因素 存活率 

分 类 号：R657.3[医药卫生—外科学]