CAJ | 학술논문

目的探索心脏死亡器官捐献(DCD)和该类器官临床移植的效果.方法捐献者因严重脑外伤致植物状态,复醒治疗2年余无效,在心跳及自主呼吸完全停止,且抢救无效,宣告死亡,按照当时地方有关条例书面完成器官及遗体捐献知情同意及相关法律程序,在纯氧辅助呼吸及持续体外心脏按压支持情况下,采取原位灌洗,整块切取双肾.供肾经组织学评估后分别移植给2例慢性肾功能衰竭患者,其中1例(受者一)为捐献者亲生父亲.术后采用环孢素A+吗替麦考酚酯+甲泼尼龙预防排斥反应.结果供肾热缺血时间为40 min,冷缺血时间为8h.术后2例均出现移植肾功能恢复延迟,分别于术后6周和4周恢复正常功能.术后第42个月,2例均出现慢性移植肾肾病改变.受者一现存活77个月,生活质量尚满意；受者二于术后第56个月死于肺部真菌感染.结论供肾热缺血时间的长短是DCD供器官能否利用的决定性因素,捐献者心脏死亡后的良好维持及器官获取团队的疾速反应是缩短热缺血时间的保证,而伦理学评估和相关法律程序的准备是前提.
목적 탐색심장사망기관연헌(DCD)화해류기관림상이식적효과.방법 연헌자인엄중뇌외상치식물상태,복성치료2년여무효,재심도급자주호흡완전정지,차창구무효,선고사망,안조당시지방유관조례서면완성기관급유체연헌지정동의급상관법률정서,재순양보조호흡급지속체외심장안압지지정황하,채취원위관세,정괴절취쌍신.공신경조직학평고후분별이식급2례만성신공능쇠갈환자,기중1례(수자일)위연헌자친생부친.술후채용배포소A+마체맥고분지+갑발니룡예방배척반응.결과 공신열결혈시간위40 min,랭결혈시간위8h.술후2례균출현이식신공능회복연지,분별우술후6주화4주회복정상공능.술후제42개월,2례균출현만성이식신신병개변.수자일현존활77개월,생활질량상만의；수자이우술후제56개월사우폐부진균감염.결론 공신열결혈시간적장단시DCD공기관능부이용적결정성인소,연헌자심장사망후적량호유지급기관획취단대적질속반응시축단열결혈시간적보증,이윤리학평고화상관법률정서적준비시전제.
Objective A new field of organ donation after cardiac death (DCD) has been explored to create additional source to clinic transplantation in China.Methods A 33-years old male patient underwent permanent vegetation state for more than 2 years in ICU after severe head injury.His relatives gave writing consent to donate his organs in order to save his renal failure father and others,if possible,in case of cardiac death.On July 27,2005,the patient's heart arrested.Clinic death was announced.The case was immediately referred to transplant team and Maastricht-V DCD organ procurement was emergently performed and two kidneys were harvested. Estimated warm ischemic time was about 40 min followed by 8 h cold ischemic time.Two adults received the grafts.One of recipients was donor's biological father,namely it was the first case of deceased related renal transplantation (DRRTx) in China.Results Both recipients developed delayed graft function postoperatively and eventually recovered after few weeks.By submission of this article,the DRRTx patient has survived with normal renal function for 77 months (6 years and 5 months).Unfortunately,other patient died from fungus pneumonia after 56 months with normal renal function.Conclusion Non-controlled Maastricht-V DCD could be an additional source to transplantation if prompt reaction could be taken.