脂肪变性供肝在成人劈离式肝移植中的应用  

Application of donor liver with steatosis in adult split liver transplantation

作　　者：傅斌生[1] 冯啸[1] 杨卿[1] 曾凯宁[1] 姚嘉[1] 唐晖[1] 刘剑戎[1] 魏绪霞[1] 易慧敏[1] 易述红[1] 陈规划[1] 杨扬[1] Fu Binsheng;Feng Xiao;Yang Qing;Zeng Kaining;Yao Jia;Tang Hui;Liu Jianrong;Wei Xuxia;Yi Huimin;Yi Shuhong;Chen Guihua;Yang Yang(Center for Liver Surgery and Liver Transplantation,the Third Affiliated Hospital of Sun Yat-sen University,Organ Transplantation Research Center of Guangdong Province,Key Laboratory for Liver Disease Research of Guangdong Province,Transplantation Engineering Medicine Laboratory,Organ Transplantation Research Institute of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院肝脏外科暨肝脏移植中心,广东省器官移植研究中心,广东省肝脏疾病研究重点实验室,广东省移植医学工程实验室,中山大学器官移植研究所,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2024年第6期789-794,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家重点研发计划项目(2017YFA0104304);国家自然科学基金(81972286,81770648);广东省自然科学基金(2020A1515010574,2020A1515010302);广东省科技计划项目(2017B020209004,2019B020236003,2020B1212060019);广州市科技计划项目(201803040005)

摘　　要：目的探讨脂肪变性供肝在成人劈离式肝移植(SLT)中应用的安全性和临床疗效。方法回顾性分析2014年7月至2022年1月在中山大学附属第三医院行SLT的67例供受体临床资料。供受者或(和)家属均签署知情同意书,符合医学伦理学规定。供者男56例,女11例,平均年龄(33±13)岁;DBD 60例,DCD 7例。67例受者中,男51例,女16例,平均年龄(51±12)岁;原发病包括乙型病毒性肝炎(乙肝)或丙型病毒性肝炎(丙肝)后肝硬化24例,肝恶性肿瘤20例,肝衰竭21例,遗传代谢性疾病2例;终末期肝病模型(MELD)评分中位数为25(8~40)分。供者和受者经过严格筛选和匹配,选择循环稳定的供者,尽可能缩短冷缺血时间≤8 h,供者血钠水平<160 mmol/L,并优化供肝获取劈分流程。根据供肝脂肪变性分级,将接受相应供肝的受者分为S0组(脂肪变性程度<10%)和S1组(脂肪变性程度介于10%~20%)。观察术后两组受者的移植肝功能恢复情况及围手术期并发症发生率和预后。术后7 d早期移植物功能障碍(EAD)发生率比较采用χ^(2)检验;术后生存分析采用Kaplan-Meier法和Log-rank检验。结果S0组和S1组术后血管并发症发生率分别为6%(3/54)、0,胆道并发症发生率分别为7%(4/54)、8%(1/13),术后EAD发生率分别为13%(7/54)和23%(3/13),差异均无统计学意义(P>0.05)。67例受者均接受随访,术后随访时间13~115个月,中位随访时间57个月,随访期间死亡6例,其中S0组4例,S1组2例。两组术后30 d内均无死亡患者。S0组肝移植受者术后1、3年生存率分别为98.1%、92.4%,S1组分别为92.3%、80.8%,差异无统计学意义(χ^(2)=0.726,P=0.394)。结论脂肪变性程度<10%的供肝可用于SLT;对于脂肪变性程度介于10%~20%的供肝,通过在体劈离、冷缺血时间控制、更高的移植物重量与受者体重比(GRWR)和严格的受者选择等措施,亦可谨慎安全地在成人受体中实施SLT。Objective To evaluate the safety and clinical efficacy of donor livers with steatosis in adult split liver transplantation(SLT).Methods Clinical data of 67 donors and recipients who underwent SLT in the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to January 2022 were retrospectively analyzed.The informed consents of all donors and recipients or(and)their families were obtained and the local ethical committee approval was received.56 donors were male and 11 female,aged(33±13)years on average,and 60 donors were DBD and 7 cases were DCD.Among 67 recipients,51 cases were male and 16 female,with an average age of(51±12)years.Primary diseases included 24 cases of liver cirrhosis induced by viral hepatitis B(HBV)or viral hepatitis C(HCV),20 cases of malignant liver tumors,21 cases of liver failure and 2 cases of hereditary metabolic diseases,respectively.The median model for end-stage liver disease(MELD)score was 25(8-40).After strict screening and matching of the donors and recipients,the donors with stable circulation were selected.The cold ischemia time(CIT)was shortened to≤8 h.The serum sodium levels of the donors were maintained at<160 mmol/L.The process of donor liver splitting was optimized.According to the grading of donor liver steatosis,the recipients who were transplanted with corresponding donor livers were divided into the S0 group(degree of steatosis<10%)and S1 group(degree of steatosis between 10%and 20%).The recovery of liver allograft function,the incidence of perioperative complications and clinical prognosis were observed two groups.The incidence of early allograft dysfunction(EAD)at postoperative 7 d was compared with Chi-square test.Postoperative survival analysis was conducted by using Kaplan-Meier method and Log-rank test.Results In the S0 and S1 groups,the incidence of vascular complications was 6%(3/54)and 0,7%(4/54)and 8%(1/13)for biliary complications,and 13%(7/54)and 23%(3/13)for postoperative EAD,respectively,and no significant differences were observed between two

关 键 词：脂肪变性供肝 劈离式肝移植 早期肝功能障碍 

分 类 号：R657.3[医药卫生—外科学]