感染肝吸虫的肝脏作为移植供肝的可行性（附14例报告）

The use of liver grafts infested with Clonorchis sinensis for liver transplantation： a report of 14 cases

目的探讨感染肝吸虫的肝脏作为移植供肝的可行性。方法14例肝功能衰竭患者接受感染肝吸虫的供肝移植。均为尸体供肝，供者生前均未诊断肝吸虫病，肝功能正常。供肝均采用快速切取技术获取，用UW液灌洗、保存，供肝热缺血时间为（4．0±2．1）min，冷缺血时间为（582±167）min。肝脏保存之后在供肝胆管中发现肝吸虫成虫，由此确定供肝感染肝吸虫。14例患者均接受经典原位肝移植术，常规留置T管。术后2～4d开始给予吡喹酮，每天3次，每次25mg／kg，2d为一个疗程。采用他克莫司、霉酚酸酯和肾上腺皮质激素联用预防排斥反应。观察患者生存状况、早期肝功能恢复情况以及胆管并发症发生率。术后第7天和3个月留取胆汁，涂片找肝吸虫虫卵。结果移植前1例供肝存在小叶间胆管轻度增生，1例为轻度大泡性脂肪肝（5％），其余供肝组织均正常。术后随访时间中位数为31个月，移植物1年和3年存活率分别为85．7％和78．6％。所有患者术后早期肝功能均迅速改善，无移植物原发无功能或功能恢复延迟出现。术后发生胆管并发症2例（14．3％，2／14），1例为肝内胆管狭窄（术后3个月）．另1例为胆总管结石（术后2年）。术后全部患者的胆汁中均未发现肝吸虫虫卵。结论感染肝吸虫的肝脏可以作为移植供肝，但此类供肝的选择标准尚待探讨。

Objective To study the feasibility of the use of liver grafts infested with Clonorchis sinensis for liver transplantation. Methods Fourteen cadaveric liver grafts infested with Clonorchis sinensis were used for liver transplantation since 2003. The donor＇s liver functions were normal and all the donors were unsuspected to be infested with Clonorchis sinensis before organ procurement. The liver grafts were flushed and preserved with UW solution. Warm ischemic time was 4. 0 ± 2. 1 min and cold ischemic time was 582± 167 min. Dead carcasses of parasite were encountered after organ procurement and the donors were confirmed to be infested with Clonorchis sinensis. Orthotopic liver transplantation with T tube was done in all the 14 patients. Praziquantel was administered to the recipients three times every day （25 mg/kg every time） from 2-4 days after operation for 2 days. Tacrolimus, mycophenolate mofetil and steroid were used for prevention of rejection. The survival of patients, liver function in early stage postoperation and the rate of biliary complications were observed. The bile was checked for ova of Clonorchis sinensis in all recipients at the 7th day and 3rd month after operation. Results The biopsy of liver grafts was normal except one liver graft had intertobular bile duct hyperplasia and one another had mild macrovesicular steatosis （5 %）. The median follow-up time was 31 months. The 1-, and 3-year graft survival rate was 85.7% and 78. 6% respectively. No primary graft nonfunction and primary graft dysfunction were observed. The incidence of biliary complication was 14. 3% （2/14）： one case of bile duct stricture and one case of common bile duct stone. Repeated examination of bile for ova of Clonorehis sinensis in all recipients was negative. Conclusion The liver grafts infested with Clonorchis sinensis can be used for liver transplantation and its clinical result is satisfied, but the inclusion criteria of this kind of liver grafts was not sure.