心脏死亡供者供肝移植三例报告
심장사망공자공간이식삼례보고
Liver transplantation from donation after cardiac death (report of 3 cases)
  • 万方数据
    中华器官移植杂志 중화기관이식잡지
    CHINESE JOURNAL OF ORGAN TRANSPLANTATION
    2011年 12期 716-718 ,共3页

    刘树荣%吴刚%成东华%孟一曼%李桂臣%杨蕾%李弘%李柏峰%王凤山%程颖%石蕊%金莹%刘永锋

    류수영%오강%성동화%맹일만%리계신%양뢰%리홍%리백봉%왕봉산%정영%석예%금형%류영봉

    心脏死亡%组织供者%肝移植 心髒死亡%組織供者%肝移植
    심장사망%조직공자%간이식
    Cardiac death%Tissue donors%Liver transplantation
    目的 总结心脏死亡器官捐献(DCD)供肝移植的临床经验.方法 共有7例心脏死亡器官捐献者,原发病包括脑出血3例(其中1例合并高血压),颅脑外伤2例,脑基底动脉闭塞1例,颅脑肿瘤(脑胶质瘤Ⅱ级)卒中1例.依据《中国心脏死亡器官捐献指南》实施捐献,采用腹部器官联合快速切取方法切取器官.受者的原发疾病为乙型肝炎后肝硬化(失代偿期)和原发性肝癌.术后预防感染,根据凝血酶原时间采取抗凝治疗,采用他克莫司+吗替麦考酚酯+泼尼松预防排斥反应.结果 有3例供者分别因合并酒精性肝硬化、家属拒绝捐献肝脏和肝脏热缺血时间超过30 min而未能切取肝脏,1例由红十字会协调至其他移植中心,3例完成肝移植.供肝热缺血时间分别为7.5、9和10 min,冷缺血时间为4.5、8.2和6.5h.受者术后随访2～9个月,术后近期无原发性移植物无功能,未发生血栓形成和排斥反应等并发症,肝功能恢复良好,均顺利出院.结论 DCD供肝移植的近期效果良好,选择可控制的中国三类供者、中高度风险的UW评分以及较短的热缺血时间是保障肝移植成功的重要因素.
    목적 총결심장사망기관연헌(DCD)공간이식적림상경험.방법 공유7례심장사망기관연헌자,원발병포괄뇌출혈3례(기중1례합병고혈압),로뇌외상2례,뇌기저동맥폐새1례,로뇌종류(뇌효질류Ⅱ급)졸중1례.의거《중국심장사망기관연헌지남》실시연헌,채용복부기관연합쾌속절취방법절취기관.수자적원발질병위을형간염후간경화(실대상기)화원발성간암.술후예방감염,근거응혈매원시간채취항응치료,채용타극막사+마체맥고분지+발니송예방배척반응.결과 유3례공자분별인합병주정성간경화、가속거절연헌간장화간장열결혈시간초과30 min이미능절취간장,1례유홍십자회협조지기타이식중심,3례완성간이식.공간열결혈시간분별위7.5、9화10 min,랭결혈시간위4.5、8.2화6.5h.수자술후수방2～9개월,술후근기무원발성이식물무공능,미발생혈전형성화배척반응등병발증,간공능회복량호,균순리출원.결론 DCD공간이식적근기효과량호,선택가공제적중국삼류공자、중고도풍험적UW평분이급교단적열결혈시간시보장간이식성공적중요인소.
    Objective To summarize our experience in the liver transplantation from the donation after cardiac death (DCD).Methods The livers from three DCD donors (2 cases of brain trauma and 1 case of cerebral hemorrhage) were harvested according to the Guidelines for Donation after Cardiac Death in China.These grafts were orthotopically transplanted into three recipients including 2 cases of decompensative hepatic cirrhosis and 1 case of primary liver cancer.The warm ischemic time ranged from 7.5 to 10 min and the cold ischemic time was 4.5,8.2 and 6.5 h respectively.Postoperative immunosuppressive regimens included prednisone,FK506 and mycophenolate mofetil (MMF).Antibiotics and anticoagulatants were used accordingly.Results All of the 3 recipients obtained normal liver function within 3 weeks since the grafts were implanted without PNF,thrombosis and rejection.No postoperative complications occurred in 3 recipients during the follow-up period of 2 to 9 months with normal liver function.Conclusion The liver transplant from DCD donor showed good results in our center.Chinese group Ⅲ of DCD donor,UW score above the middle level and the short warm ischemic time are three keys ensuring the success of the liver transplant from DCD donors.
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