儿童心脏死亡器官捐献供者供肝移植11例疗效分析  

Outcomes in pediatric liver transplantation using grafts from children donors after cardiac death from a single center

作　　者：张明满[1] 戴小科[1] 任志美[1] 蒲从伦[1] 李英存[1] 康权[1] 张桂芳[1] 熊强[1] 邓玉华[1] 陈柏林[1] 胡键阳[1] 

机构地区：[1]重庆医科大学附属儿童医院,400014

出　　处：《中华器官移植杂志》2014年第2期94-98,共5页Chinese Journal of Organ Transplantation

摘　　要：目的评估儿童心脏死亡器官捐献（DCD）供者供肝婴幼儿肝移植的临床疗效。方法回顾性分析2011年11月至2013年5月间完成的11例儿童DCD供肝移植的临床资料。11例供肝均为儿童DCD供肝，由中国人体器官分配与共享系统（COTRS）获得。原发疾病为颅脑外伤8例、缺血缺氧性脑病2例及颅内良性肿瘤i例，年龄7个月～9岁。11例受者中男孩3例，女孩8例，原发病为胆道闭锁伴胆汁性肝硬化9例，急性肝坏死和肝糖原累积症各1例，儿童终末期肝病模型（PELD）评分为8．5～31．5，移植时年龄4个月～5岁，体质量5～20kg。供、受者血型相同4例、相容7例。供肝重量为180~690g。经典式肝移植9例，背驮式肝移植2例，8例为全肝移植，3例为减体积肝移植。胆管-空肠Roux-en-Y吻合9例，胆道端端吻合2例。移植后9例采用以环孢素A为主的免疫抑制方案，其中1例后将环孢素A替换为他可莫司；2例采用以他可莫司为主的免疫抑制方案。结果供肝热缺血时间平均为4．3min，冷缺血时间平均为10h。平均手术耗时10．9h，无肝期78min。移植肝重量与受者标准肝体积比（GV／SLV）平均为1．15，移植肝重量与受者体质量比（GRwR）平均为4．35％。术后并发症包括肝动脉血栓（HAT）4例，原发性移植物无功能（PNF）1例，门静脉血栓1例，腹腔血肿和乳糜腹水各1例。住院时间21～52d。随访期3～21个月，4例（36％）死亡，7例（64％）痊愈，目前均健康生活。结论儿童DCD供肝可以成为儿童肝移植的肝源，术后HAT发生率高，是影响肝移植疗效的主要因素，需积累经验和改进技术以提高成功率。Objective To evaluate the clinical outcome in pediatric liver transplantation （LT） using the grafts from children donors after cardiac death （DCD）. Method The clinical data of 11 children aged from 4 months to 5 years who underwent LT operation using the graft from children DCD between Nov. 2011 and May 2013 in our hospital were analyzed retrospectively. The 11 livers were taken out of the DCD by China organ transplant response system. The 11 donors were children aged from 7 months to 9 years who died of irreversible anoxic cerebral damage, severe brain injuries and intracalvarium benign tumor. The 11 recipients were 3 boys and 8 girls. There were 9 children with severe cirrhosis with biliary atresia, one with fulminant liver failure and one with hepato- glycogenosis. The recipient^s weight at the time of LT was 6. 5-20 kg. The recipients＂ pediatric end- stage liver disease scoring was 8. 5- 31. 5. Nine DCD livers including 3 reduced-size livers were classic-orthotopically transplanted into the 9 recipients respectively and 2 DCD livers were subjected to piggyback liver transplantation. Biliary tract was reconstructed via Roux-en-Y operation in 9 recipients and the common hepatic duct was end-to-end anastomosed in 2 cases. The blood type of donor to recipient was identical in 4 cases and compatible in 7 cases, tacrolimus, mycophenolate mofetil and prednisone were used for postoperative immunosuppression. Result The everage weight of 11 DCD livers was 180-690 g, the mean warm ischemia time was 4. 3 rain, and the mean cold ischemia time was 10 h. The mean operation time of 11 recipients was 10. 94 h, and the mean anhepatic phase was 78 rain. The graft to recipient weight ratio （GRWR） was 2. 25-7. 54% （mean 4. 35%） and the graft volume to the standard liver volume （GV/SLV） was 0.67 - 2.13 （mean 1.15）. The postoperative complications included hepatic artery thrombus （HAT） in 4 cases, primary non-function （PNF） in one case, portal vein thrombus in 1 case, peritoneal cavity hematoma in

关 键 词：心脏死亡器官捐献 儿童 供者 肝移植 

分 类 号：R726.5[医药卫生—儿科]