中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
Chinese Journal of Organ Transplantation
2015年
6期
346-350
,共5页
郭文治%温培豪%张嘉凯%潘洁%李功权%史晓奕%杨翰%曹胜利%张水军
郭文治%溫培豪%張嘉凱%潘潔%李功權%史曉奕%楊翰%曹勝利%張水軍
곽문치%온배호%장가개%반길%리공권%사효혁%양한%조성리%장수군
肝移植%肝功能不全%高钠血症%供者选择
肝移植%肝功能不全%高鈉血癥%供者選擇
간이식%간공능불전%고납혈증%공자선택
Liver transplantation%Hepatic insufficiency%Hyponatremia%Donor Selection
目的 总结公民逝世后器官捐献(DCD)的单中心治疗经验,探讨供者选择对受者早期预后的影响.方法 回顾性分析2010年10月至2014年12月单中心94例DCD供者和受者的临床资料.结果 94例中,高钠血症供者26例,血清钠为155～160 mmol/L和160～180 mmol/L者分另有15例和11例,其术后早期移植肝功能不全发生率分别为20.0％和18.2％,与正常血清钠供者相应受者(移植肝功能不全发生率为22.1％)相比较,发生率的差异无统计学意义(P=0.861,P=0.772).脂肪肝供肝15例(轻度14例,中度1例),术后早期移植肝功能不全发生率为26.7％,与无脂肪肝供肝(术后早期移植肝功能不全发生率为20.3％)相比较,发生率的差异无统计学意义(P=0.832).6例儿童供肝成人受者,术后血管并发症与胆道并发症发生率分别为16.7％和16.7％,与成人供肝术后(血管并发症和胆道并发症发生率分别为4.8％和19.3％)相比较,发生率的差异无统计学意义(P=0.301,P=1.000).供肝冷缺血时间＞10 h的相应受者术后早期移植肝功能不全发生率为25.0％,供肝冷缺血时间≤10 h的相应受者术后早期移植肝功能不全发生率为20.2％,差异无统计学意义差异(P=0.880).对于使用多巴胺和多巴胺联合去甲肾上腺素维持血压的供者,相应受者术后早期移植肝功能不全的发生率为18.3％和26.7％;对于没有使用药物维持血压的供者,相应受者术后早期移植肝功能不全的发生率为26.3％,发生率的差异无统计学意义(P=0.325,P=0.640).术后1、3年移植物及受者存活率分别为92.2％和85.7％.结论 综合评估供者、受者整体情况,谨慎地拓宽DCD在高钠血症供者、脂肪肝供肝、儿童供肝成人受者、冷缺血时间等方面的标准,对受者早期预后未见明显不良影响.
目的 總結公民逝世後器官捐獻(DCD)的單中心治療經驗,探討供者選擇對受者早期預後的影響.方法 迴顧性分析2010年10月至2014年12月單中心94例DCD供者和受者的臨床資料.結果 94例中,高鈉血癥供者26例,血清鈉為155～160 mmol/L和160～180 mmol/L者分另有15例和11例,其術後早期移植肝功能不全髮生率分彆為20.0％和18.2％,與正常血清鈉供者相應受者(移植肝功能不全髮生率為22.1％)相比較,髮生率的差異無統計學意義(P=0.861,P=0.772).脂肪肝供肝15例(輕度14例,中度1例),術後早期移植肝功能不全髮生率為26.7％,與無脂肪肝供肝(術後早期移植肝功能不全髮生率為20.3％)相比較,髮生率的差異無統計學意義(P=0.832).6例兒童供肝成人受者,術後血管併髮癥與膽道併髮癥髮生率分彆為16.7％和16.7％,與成人供肝術後(血管併髮癥和膽道併髮癥髮生率分彆為4.8％和19.3％)相比較,髮生率的差異無統計學意義(P=0.301,P=1.000).供肝冷缺血時間＞10 h的相應受者術後早期移植肝功能不全髮生率為25.0％,供肝冷缺血時間≤10 h的相應受者術後早期移植肝功能不全髮生率為20.2％,差異無統計學意義差異(P=0.880).對于使用多巴胺和多巴胺聯閤去甲腎上腺素維持血壓的供者,相應受者術後早期移植肝功能不全的髮生率為18.3％和26.7％;對于沒有使用藥物維持血壓的供者,相應受者術後早期移植肝功能不全的髮生率為26.3％,髮生率的差異無統計學意義(P=0.325,P=0.640).術後1、3年移植物及受者存活率分彆為92.2％和85.7％.結論 綜閤評估供者、受者整體情況,謹慎地拓寬DCD在高鈉血癥供者、脂肪肝供肝、兒童供肝成人受者、冷缺血時間等方麵的標準,對受者早期預後未見明顯不良影響.
목적 총결공민서세후기관연헌(DCD)적단중심치료경험,탐토공자선택대수자조기예후적영향.방법 회고성분석2010년10월지2014년12월단중심94례DCD공자화수자적림상자료.결과 94례중,고납혈증공자26례,혈청납위155～160 mmol/L화160～180 mmol/L자분령유15례화11례,기술후조기이식간공능불전발생솔분별위20.0％화18.2％,여정상혈청납공자상응수자(이식간공능불전발생솔위22.1％)상비교,발생솔적차이무통계학의의(P=0.861,P=0.772).지방간공간15례(경도14례,중도1례),술후조기이식간공능불전발생솔위26.7％,여무지방간공간(술후조기이식간공능불전발생솔위20.3％)상비교,발생솔적차이무통계학의의(P=0.832).6례인동공간성인수자,술후혈관병발증여담도병발증발생솔분별위16.7％화16.7％,여성인공간술후(혈관병발증화담도병발증발생솔분별위4.8％화19.3％)상비교,발생솔적차이무통계학의의(P=0.301,P=1.000).공간랭결혈시간＞10 h적상응수자술후조기이식간공능불전발생솔위25.0％,공간랭결혈시간≤10 h적상응수자술후조기이식간공능불전발생솔위20.2％,차이무통계학의의차이(P=0.880).대우사용다파알화다파알연합거갑신상선소유지혈압적공자,상응수자술후조기이식간공능불전적발생솔위18.3％화26.7％;대우몰유사용약물유지혈압적공자,상응수자술후조기이식간공능불전적발생솔위26.3％,발생솔적차이무통계학의의(P=0.325,P=0.640).술후1、3년이식물급수자존활솔분별위92.2％화85.7％.결론 종합평고공자、수자정체정황,근신지탁관DCD재고납혈증공자、지방간공간、인동공간성인수자、랭결혈시간등방면적표준,대수자조기예후미견명현불량영향.
Objective To summarize the experience of liver transplantation with donation after citizens death (DCD),and explore the influence of donor selection on the early prognosis of recipients in single center.Method The clinical data of 94 cases of donors and recipients from October 2010 to December 2014 were analyzed retrospectively.Result The hypernatremia was observed in 26 cases.The levels of blood sodium in 155～160 mmol/L and 160～80 mmol/L were found in 15 cases and 11 cases with the early graft dysfunction rate postoperation being 20.0％ and 18.2％,respectively.There was no statistically significant difference as compared with that in normal serum sodium (22.1％;P=0.861,and P=0.772).Steatosis liver was found in 15 donors (mild in 14 cases,and moderate in 1 case) with the rate of early graft dysfunction being 26.7％.There was no statistically significant difference compared to that without steatosis liver after transplantation (20.3％;P =0.832).Six cases of liver transplantations from children to adults were accomplished,and the incidence of the vascular and biliary complications was 16.7％ and 16.7％,respectively.There was no statistically significant difference compared with that in adults to adults liver transplantation (4.8 ％ and 19.3％;P=0.301,P =1.000).The rate of early graft dysfunction with cold ischemia time ＞10 h and ≤10 h was 25.0％ and 20.2％ respectively (P =0.880).The rate of early graft dysfunction by using dopamine alone and dopamine combined with norepinephrine to maintain blood pressure was 18.3％ and 26.7％,respectively,which was not significantly different from that without using drugs after operation (26.3％;P =0.325,P =0.640).The 1-and 3-year survival rate of grafts and patients after operation was 92.2％ and 85.7％,respectively.Conclusion There was no undesirable influence on early prognosis postoperation to prudently extend the standards of DCD in donors with high serum sodium,steatosis liver,children liver to adult recipients,cold ischemia time,etc on the basis of comprehensively evaluating the status of donors and recipients.
