CAJ | 학술논문

目的总结公民逝世后脑-心双死亡标准器官捐献(DBCD)供肝的评估经验,并探讨DBCD供肝临床选择的标准.方法回顾性分析广东省佛山市第一人民医院自2011年11月至2014年10月期间实施DBCD供肝30例的供、受者资料.结果 30例DBCD供者的年龄为(35±12)岁(15～59岁);在供者肝脏获取前所检测的AST中位数为73 U/L,95％可信区间为45～313U/L;ALT中位数为62 U/L,95％可信区间为35～221 U/L;血清Na+中位数为146 mmol/L,95％可信区间为146～155mmol/L.供肝的热缺血时间为(9.0±4.9)min,冷缺血时间为(5.4±2.1)h.移植后受者发生早期移植肝功能不全10例,胆管狭窄4例,胆漏2例,肝动脉夹层动脉瘤1例,移植后均未出现原发性移植肝无功能.2例受者死亡,术后1年移植物及受者存活率均为95.7％(22/23),术后2年移植物及受者存活率均为93.3％(14/15).结论 DBCD供肝的临床选择应综合参考供者年龄、肝功能、血清Na+、供肝热缺血时间、冷缺血时间、脂肪变性情况,及供、受者乙型肝炎血清学检查结果和血型配型情况.对DBCD供肝的临床情况进行早期评估,谨慎的扩大供肝临床选择的标准,可有效扩大器官来源,保障移植效果.
목적 총결공민서세후뇌-심쌍사망표준기관연헌(DBCD)공간적평고경험,병탐토DBCD공간림상선택적표준.방법 회고성분석광동성불산시제일인민의원자2011년11월지2014년10월기간실시DBCD공간30례적공、수자자료.결과 30례DBCD공자적년령위(35±12)세(15～59세);재공자간장획취전소검측적AST중위수위73 U/L,95％가신구간위45～313U/L;ALT중위수위62 U/L,95％가신구간위35～221 U/L;혈청Na+중위수위146 mmol/L,95％가신구간위146～155mmol/L.공간적열결혈시간위(9.0±4.9)min,랭결혈시간위(5.4±2.1)h.이식후수자발생조기이식간공능불전10례,담관협착4례,담루2례,간동맥협층동맥류1례,이식후균미출현원발성이식간무공능.2례수자사망,술후1년이식물급수자존활솔균위95.7％(22/23),술후2년이식물급수자존활솔균위93.3％(14/15).결론 DBCD공간적림상선택응종합삼고공자년령、간공능、혈청Na+、공간열결혈시간、랭결혈시간、지방변성정황,급공、수자을형간염혈청학검사결과화혈형배형정황.대DBCD공간적림상정황진행조기평고,근신적확대공간림상선택적표준,가유효확대기관래원,보장이식효과.
Objective To summarize the experience of donor evaluation from donation after brain death and cardiac death (DBCD) and discuss the clinical donor selection criteria.Method The clinical data of 30 patients with liver transplantation,receiving donation after brain death and cardiac death from November 2011 to October 2014 were retrospectively analyzed.Result In this dataset,the age of donors was 15-59 years old with a mean of 35 ± 12;the median aspartic transaminase (AST) and alanine aminotransferase (ALT) levels of donors before procurement were 73 U/L and 62 U/L respectively with the 95％ confidence interval being 45-313 U/L and 35-221 U/L respectively.The median serum sodium of donors was 146 mmol/L with the 95％ confidence interval being 146-155 mmol/L.The mean warm ischemia time of donors was 9.0 ± 4.9 min,and the mean cold ischemia time was 5.4 ± 2.1 h.There were 10 cases of initial poor function,4 cases of biliary stricture,2 cases of biliary leak and 1 case of hepatic artery dissection aneurysm in 30 cases.No cases had primary nonfunction.Two recipients died.The 1-and 3-year graft and patient survival rate was 95.7％,95.7％,93.3 ％ and 93.3 ％ respectively.Conclusion Choosing DBCD donors should not only take into donor clinical variables account as follows:age,liver function,warm ischemia time,cold ischemia time,steatosis,also be attention to hepatitis B serology and blood type of donor and recipient.It will increase organ donations and obtain better transplant outcomes as a result of evaluating organ donors early and extending the clinical donor selection criteria prudently.