目的 探讨心脏死亡器官捐献(DCD)肝移植的临床疗效.方法 回顾性分析2008年12月至2013年7月天津市第一中心医院收治的52例行心脏死亡器官捐献(DCD)肝移植终末期肝病患者的临床资料,其中未成年患者(年龄＜18岁)21例,成人患者(年龄≥18岁)31例.分析患者术中、术后及预后情况.出院后患者通过天津市第一中心医院东方器官移植随访中心定期随访,随访时间截至2014年7月31日.正态分布的计量资料以(x)±s表示,组间比较采用重复测量的方差分析.累积生存率采用Kaplan-Meier法计算.结果 21例未成年受者中16例行原位肝移植,5例采用成人DCD供肝行劈离式肝移植.供肝质量、移植物与受者体质量比(GRWR)、热缺血时间、冷缺血时间、无肝期时间、静脉输液总量、手术时间、术中出血量分别为(338 ±34)g、1.9％±0.7％、(16±6)min、(86±36) min、(43±10) min、(816±662) mL、(7.1 ±1.5)h、(329±214) mL.患者术后未发生腹腔积液、急性细胞排斥反应、门静脉血栓形成及胆道并发症.术后住院时间为(41 ±23)d.未成年受者Hb和Alb由术前水平逐渐增加,至术后14 d达到正常水平分别为(101±19)g/L～ (128±23)g/L和(34±7) g/L ～ (44±7)g/L,手术前后比较,差异均有统计学意义(F=3.943,7.340,P＜0.05).血清TBiL、AST、ALT由术前水平逐渐降低,至术后14 d接近正常水平,分别为(307±69) μmol/L～(34±17) μmol/L、(88±34) U/L～(36±17) U/L、(154 ±51)U/L～(46±18) U/L,手术前后比较,差异均有统计学意义(F=142.200,17.060,31.750,P＜0.05).31例成人受者均采用成人DCD供肝,手术方式均为原位肝移植.供肝质量、GRWR、热缺血时间、冷缺血时间、无肝期时间、静脉输液总量、手术时间、术中出血量分别为(1104 ±43)g、1.7％±0.4％、(16 ±4) min、(89±43) min、(47±9)min、(2 515 ±1 803)mL、(7.9±1.8)h、(1 208±548) mL.术后14例患者发生并发症,其中腹腔积液8例、急性细胞排斥反应3例、门静脉血栓形成2例、胆道并发症1例.术后住院时间为(44±22)d.成人受者术后Alb水平逐渐增加,至术后14 d达到正常水平(31±5) g/L ～ (40 ±5) g/L,手术前后比较,差异有统计学意义(F=14.930,P＜0.05).血清TBiL、AST、ALT由术前水平逐渐降低,至术后14 d接近正常水平,分别为(182±55) μmol/L～(62±22) μmol/L、(286±93) U/L ～ (79 ±47) U/L、(349± 111)U/L～(76±28)U/L,手术前后比较,差异有统计学意义(F =34.350,71.070,82.680,P＜0.05).52例患者均获得随访,中位随访时间为544 d(196 ～1 953 d).患者1年生存率为90.38％.随访期间未成年受者因肺部感染和大出血各死亡1例;成人受者因肺部感染、原发性移植物功能障碍、大出血各死亡1例.结论 DCD肝移植是治疗终末期肝病可行的选择,患者可获得良好的短期临床疗效.
目的 探討心髒死亡器官捐獻(DCD)肝移植的臨床療效.方法 迴顧性分析2008年12月至2013年7月天津市第一中心醫院收治的52例行心髒死亡器官捐獻(DCD)肝移植終末期肝病患者的臨床資料,其中未成年患者(年齡＜18歲)21例,成人患者(年齡≥18歲)31例.分析患者術中、術後及預後情況.齣院後患者通過天津市第一中心醫院東方器官移植隨訪中心定期隨訪,隨訪時間截至2014年7月31日.正態分佈的計量資料以(x)±s錶示,組間比較採用重複測量的方差分析.纍積生存率採用Kaplan-Meier法計算.結果 21例未成年受者中16例行原位肝移植,5例採用成人DCD供肝行劈離式肝移植.供肝質量、移植物與受者體質量比(GRWR)、熱缺血時間、冷缺血時間、無肝期時間、靜脈輸液總量、手術時間、術中齣血量分彆為(338 ±34)g、1.9％±0.7％、(16±6)min、(86±36) min、(43±10) min、(816±662) mL、(7.1 ±1.5)h、(329±214) mL.患者術後未髮生腹腔積液、急性細胞排斥反應、門靜脈血栓形成及膽道併髮癥.術後住院時間為(41 ±23)d.未成年受者Hb和Alb由術前水平逐漸增加,至術後14 d達到正常水平分彆為(101±19)g/L～ (128±23)g/L和(34±7) g/L ～ (44±7)g/L,手術前後比較,差異均有統計學意義(F=3.943,7.340,P＜0.05).血清TBiL、AST、ALT由術前水平逐漸降低,至術後14 d接近正常水平,分彆為(307±69) μmol/L～(34±17) μmol/L、(88±34) U/L～(36±17) U/L、(154 ±51)U/L～(46±18) U/L,手術前後比較,差異均有統計學意義(F=142.200,17.060,31.750,P＜0.05).31例成人受者均採用成人DCD供肝,手術方式均為原位肝移植.供肝質量、GRWR、熱缺血時間、冷缺血時間、無肝期時間、靜脈輸液總量、手術時間、術中齣血量分彆為(1104 ±43)g、1.7％±0.4％、(16 ±4) min、(89±43) min、(47±9)min、(2 515 ±1 803)mL、(7.9±1.8)h、(1 208±548) mL.術後14例患者髮生併髮癥,其中腹腔積液8例、急性細胞排斥反應3例、門靜脈血栓形成2例、膽道併髮癥1例.術後住院時間為(44±22)d.成人受者術後Alb水平逐漸增加,至術後14 d達到正常水平(31±5) g/L ～ (40 ±5) g/L,手術前後比較,差異有統計學意義(F=14.930,P＜0.05).血清TBiL、AST、ALT由術前水平逐漸降低,至術後14 d接近正常水平,分彆為(182±55) μmol/L～(62±22) μmol/L、(286±93) U/L ～ (79 ±47) U/L、(349± 111)U/L～(76±28)U/L,手術前後比較,差異有統計學意義(F =34.350,71.070,82.680,P＜0.05).52例患者均穫得隨訪,中位隨訪時間為544 d(196 ～1 953 d).患者1年生存率為90.38％.隨訪期間未成年受者因肺部感染和大齣血各死亡1例;成人受者因肺部感染、原髮性移植物功能障礙、大齣血各死亡1例.結論 DCD肝移植是治療終末期肝病可行的選擇,患者可穫得良好的短期臨床療效.
목적 탐토심장사망기관연헌(DCD)간이식적림상료효.방법 회고성분석2008년12월지2013년7월천진시제일중심의원수치적52례행심장사망기관연헌(DCD)간이식종말기간병환자적림상자료,기중미성년환자(년령＜18세)21례,성인환자(년령≥18세)31례.분석환자술중、술후급예후정황.출원후환자통과천진시제일중심의원동방기관이식수방중심정기수방,수방시간절지2014년7월31일.정태분포적계량자료이(x)±s표시,조간비교채용중복측량적방차분석.루적생존솔채용Kaplan-Meier법계산.결과 21례미성년수자중16례행원위간이식,5례채용성인DCD공간행벽리식간이식.공간질량、이식물여수자체질량비(GRWR)、열결혈시간、랭결혈시간、무간기시간、정맥수액총량、수술시간、술중출혈량분별위(338 ±34)g、1.9％±0.7％、(16±6)min、(86±36) min、(43±10) min、(816±662) mL、(7.1 ±1.5)h、(329±214) mL.환자술후미발생복강적액、급성세포배척반응、문정맥혈전형성급담도병발증.술후주원시간위(41 ±23)d.미성년수자Hb화Alb유술전수평축점증가,지술후14 d체도정상수평분별위(101±19)g/L～ (128±23)g/L화(34±7) g/L ～ (44±7)g/L,수술전후비교,차이균유통계학의의(F=3.943,7.340,P＜0.05).혈청TBiL、AST、ALT유술전수평축점강저,지술후14 d접근정상수평,분별위(307±69) μmol/L～(34±17) μmol/L、(88±34) U/L～(36±17) U/L、(154 ±51)U/L～(46±18) U/L,수술전후비교,차이균유통계학의의(F=142.200,17.060,31.750,P＜0.05).31례성인수자균채용성인DCD공간,수술방식균위원위간이식.공간질량、GRWR、열결혈시간、랭결혈시간、무간기시간、정맥수액총량、수술시간、술중출혈량분별위(1104 ±43)g、1.7％±0.4％、(16 ±4) min、(89±43) min、(47±9)min、(2 515 ±1 803)mL、(7.9±1.8)h、(1 208±548) mL.술후14례환자발생병발증,기중복강적액8례、급성세포배척반응3례、문정맥혈전형성2례、담도병발증1례.술후주원시간위(44±22)d.성인수자술후Alb수평축점증가,지술후14 d체도정상수평(31±5) g/L ～ (40 ±5) g/L,수술전후비교,차이유통계학의의(F=14.930,P＜0.05).혈청TBiL、AST、ALT유술전수평축점강저,지술후14 d접근정상수평,분별위(182±55) μmol/L～(62±22) μmol/L、(286±93) U/L ～ (79 ±47) U/L、(349± 111)U/L～(76±28)U/L,수술전후비교,차이유통계학의의(F =34.350,71.070,82.680,P＜0.05).52례환자균획득수방,중위수방시간위544 d(196 ～1 953 d).환자1년생존솔위90.38％.수방기간미성년수자인폐부감염화대출혈각사망1례;성인수자인폐부감염、원발성이식물공능장애、대출혈각사망1례.결론 DCD간이식시치료종말기간병가행적선택,환자가획득량호적단기림상료효.
Objective To investigate the clinical outcomes in liver transplantation from donation after cardiac death (DCD).Methods The clinical data of 52 patients with end stage liver disease who received liver transplantation from DCD donors (the age of 21 pediatric recipients ＜ 18 years,and the age of 31 adult recipients ≥ 18 years) at the Tianjin First Central Hospital from December 2008 to July 2013 were retrospectively analyzed.The intraoperative,postoperative and prognosis data were analyzed.All patients were regularly followed up in the Transplantation Follow-up Center after discharge till July 31,2014.The measurement data with normal distribution were presented as (x) ± s.The comparison between groups was evaluated with the repeated measures ANOVA.The cumulative survival rate was done by the Kaplan-Meier method.Results Among the 21 pediatric recipients,16 received classic orthotopical liver transplantation and 5 received reduced-size liver transplantation from adult donors.The weight of 21 DCD livers,graft to recipient weight ratio (GRWR),warm ischemia time,cold ischemia time,anhepatic phase,volume of intravenous infusion,operation time and volume of intraoperative blood loss were (338 ± 34) g,1.9％ ± 0.7％,(16 ± 6) minutes,(86 ± 36) minutes,(43 ± 10) minutes,(816 ± 662) mL,(7.1 ±1.5)hours and (329 ± 214)mL,respectively.No peritoneal effusion,acute cellular rejection (ACR),portal vein thrombosis (PVT) and biliary complications occurred in the pediatric recipients.The duration of hospital stay was (41 ± 23) days.The level of hemoglobin (Hb) and albumin (Alb) to reach the normal level from pre-operation to postoperative day 14 were (101 ± 19)g/L to (128 ±23) g/L and (34 ±7)g/L to (44 ±7)g/L,respectively,with significant differences (F =3.943,7.340,P ＜ 0.05).The level of total bilirubin (TBil),aspartate transaminase (AST) and alanine transaminase (ALT) gradual reducing to the normal level from preoperation to postoperative day 14 were (307 ± 69) μmol/L to (34 ± 17) μmol/L,(88 ± 34) U/L to (36 ± 17) U/L and (154 ± 51) U/L to (46 ± 18)U/L,respectively,with significant differences (F =142.200,17.060,31.750,P ＜ 0.05).Thirtyone adult recipients received classic orthotopical liver transplantation form adult donors.The weight of 21 DCD livers,GRWR,warm ischemia time,cold ischemia time,anhepatic phase,volume of intravenous infusion,operation time and volume of blood loss were(1 104 ± 43) g,1.7％ ± 0.4％,(16 ± 4) minutes,(89 ± 43) minutes,(47 ± 9) minutes,(2 515 ± 1 803) mL,(7.9 ± 1.8) hours and (1 208 ± 548) mL,respectively.The complications occurred in 14 adult recipients,including peritoneal effusion in 8 recipients,ACR in 3 recipients,PVT in 2 recipients and biliary complications in 1 recipient.The duration of hospital stay was (44 ± 22)days.The level of Alb to reach the normal level from pre-operation to postoperative day 14 were(31 ± 5)g/L to (40 ± 5)g/L,with a significant difference (F =14.930,P ＜ 0.05).The level of TBil,AST and ALT gradual reducing to the nearly normal level from pre-operation to postoperative day 14 were (182 ± 55) μmol/L to (62 ± 22) μmol/L,(286 ±93) U/L to (79 ± 47) U/L and (349 ± 111) U/L to (76 ± 28) U/L,respectively,with significant differences (F =34.350,71.070,82.680,P ＜ 0.05).All the 52 recipients were followed up for a median time of 544 days (range,196-1 953 days),with 1-year survival rate of 90.38％.During the follow-up,1 pediatric recipient died of pulmonary infection and 1 of massive hemorrhage,and 1 adult recipient died of pulmonary infection,1 of primary graft dysfunction and 1 of massive hemorrhage.Conclusion Liver transplantation from DCD is a feasible treatment for end-stage liver diseases,with a good short-term clinical outcomes.
