心脏死亡供肝肝移植的疗效观察  

Clinical outcomes of liver transplantation from graft donation of cardiac death donors

作　　者：胡志平[1] 冷希圣[1] 黄磊[1] 王东[1] 高杰[1] 李照[1] 高鹏骥[1] 倪彦彬[1] 朱继业[1] 

机构地区：[1]北京大学人民医院肝胆外科肝硬化肝癌基础研究北京市重点实验室,100044

出　　处：《中华普通外科杂志》2016年第3期221-223,共3页Chinese Journal of General Surgery

基　　金：北京市科委基金资助项目（Z141107004414042）

摘　　要：目的 探讨心脏死亡捐献（donation after cardiac death,DCD）肝移植的临床疗效.方法 我院2013年12月至2015年6月共实施23例心脏死亡捐献肝移植,对该组23例供者受者和此前连续完成23例不可控心脏死亡供肝肝移植供者受者的临床特点及预后进行对比分析.结果DCD供者和对照组供者年龄分别为21 ～ 73岁和22 ～ 45岁,差异有统计学意义（t 2.986,P=0.000）.DCD受者和对照组受者的年龄、性别、乙型病毒性肝炎、肝癌、供受者血型相符、术前MELD（model for end-stage liver disease,MELD）评分等资料差异均无统计学意义.DCD受者和对照组受者肝移植术后ALT（alanine aminotransferase,ALT）峰值分别为（1 360±1 165） U/ml和（613±366） U/ml（t=7.914,P=0.007）,AST（aspartate aminotransferase,AST）峰值分别为（4 241±3 705） U/ml和（1 235±1 049） U/ml（t=12.867,P=0.001）,差异有统计学意义.两组受者的术中失血量、ICU停留时间和胆道并发症发生情况的差异均无统计学意义.DCD受者和对照组受者1年生存率分别为69.6％和78.3％,差异无统计学意义（X2=2.375,P=0.268）.结论DCD供肝的缺血再灌注损伤较重,但受者术后并发症发生情况和生存率与不可控心脏死亡捐献肝移植相似.Objective To investigate the outcome of liver transplantation from graft donation of cardiac death donors.Methods A total of 46 liver transplant recipients were enrolled in this study.The grafts included 23 DCD donors and 23 cases of cadaveric donors.All data of medical records and follow-up were retrospectively reviewed.Results DCD donors had a significantly younger age （45 ± 15 vs.28 ± 3,t =2.986,P =0.000） than the cadaveric donors.After transplantation DCD recipients had a higher level of ALT [（1 360 ± 1 165） U/ml vs.（613 ±366）U/ml,t =7.914,P =0.007] and AST[（4 241 ±3 705）U/ml vs.（1 235 ± 1 049）U/ml,t =12.867,P =0.001].There was no significant difference in blood loss [（4 422 ±6 645） vs.（2 789 ± 3 017）,t =1.151,P =0.289],biliary compications （13.05%vs.17.39%,x2 =0.492,P =0.681） and cumulative survival rate （69.6% vs.78.3%,x2 =2.375,P =0.268） between DCD recipients and those from cadaveric donors.Conclusions The general outcomes of DCD liver transplantation patients are comparable to those from cadaveric donors though suffering from temporary higher level of ischemic-reperfusion injury.DCD liver is a safe and effective source of graft.

关 键 词：肝移植 组织供者 心脏 死亡捐献 

分 类 号：R657.3[医药卫生—外科学]