中度脂肪变性供肝肝移植的早期疗效与安全性研究

The utility of donor liver with steatosis in liver transplantation

目的研究总结浙江大学医学院附属第一医院肝移植中心在脂肪变性供肝肝移植方面的经验并对其临床价值进行评估。方法分析2003年5月至2005年6月采用中度脂肪变性供肝(大泡性脂肪变性肝细胞占30%～60%)的24例成人肝移植受者(观察组)相关临床和随访数据,根据年龄、性别、终末期肝病模型评分和冷缺血时间进行匹配后,将24例采用无或轻度脂肪变性(大泡性脂肪变性肝细胞<30%)供肝的肝移植受者作为对照组,将两组受者资料和移植肝相关数据进行分析比较。结果移植后1周内两组间肝肾功能变化差异无统计学意义(P>0.05),两组间早期移植物功能不全和早期急性肾损伤的发生率以及术后3个月、6个月及1年受者存活率差异均无统计学意义(均P>0.05)。结论中度脂肪变性供肝在移植后早期可以发挥足够的功能,在排除其他危险因素的前提下可以安全地作为供肝系统的一部分。

Objective The discrepancy between available livers and request for transplantation has forced many centers to use marginal donors to expand the donor pool. Many previous studies have demonstrated controversial results of the applieatian of steatotie liver grafts. The aim of the present study was to summarize a single-center experience and evaluate the value of steatotic liver grafts. Methods The clinical and follow up data of 24 adult patients receiving moderate steatotic liver grafts （30%- 60% ） from May 2003 to June 2005 （ Group 1 ） were analyzed. After matching with age, gender, model for end-stage liver diseases seore, and cold isehemia time, another 24 patients receiving liver grafts with steatosis less than 30% were chosen as control （ Group 2）. The patient and graft outcomes were eompared between the 2 groups. Results No significant difference in liver and kidney functions in the early post-transplant week was found between the 2 groups （all P 〉 0.05 ）. Neither the incidences of early allograft dysfunction and aeute kidney injury nor the patient survival rates （3-month, 6-month and 1-year） showed signifieant difference between Group 1 and Group 2 （ all P 〉 0.05 ）. Conclusion Moderate steatotie liver grafts provide adequate function in the first phase after transplantation and can be reliably used for transplantation when other risk factors have been excluded.