不同冷保存时间的热缺血供肝在肝移植中的疗效

Evaluation of liver grafts with warm ischemia and with different cold preservation time in liver transplantation

目的探讨不同冷保存时间的热缺血供肝在肝移植中的疗效。方法回顾性分析2006年1月至2007年12月中山大学附属第一医院收治的154例肝移植受者采用热缺血时间≤10min的无心跳供者肝脏进行肝移植的疗效。根据冷保存时间将患者分为3组：〈8h为Ⅰ组，58例；8～12h为Ⅱ组，62例；〉12h为Ⅲ组，34例。采用方差分析、t检验和，检验分析3组肝移植术后ALT峰值、并发症、移植肝存活和受者生存情况的差异。结果3组受者术后均未发生原发性移植肝无功能。随访时间8～32个月，I组受者的A¨峰值、感染发生率、胆道并发症发生率、移植肝存活率和生存率分别为（482±357）U／L、12％（7／58）、12％（7／58）、86％（50／58）和88％（51／58），m组受者分别为（1274±608）U／L、29％（10／34）、26％（9／34）、68％（23／34）和71％（24／34），两组比较差异有统计学意义（t=5．23，x2=4．28，6．77，4．51，4．28，P〈0．05）；而Ⅱ组受者仅ALT峰值达到（953±424）U／L，与Ⅰ组比较差异有统计学意义（t=4．76，P〈0．05）。结论热缺血时间≤10min的供肝能够耐受12h的冷保存损伤，超过此时限，移植术后胆道并发症和感染的发生率显著升高，移植肝存活率和受者生存率显著降低。

Objective To evaluate the effieacy of liver grafts with warm ischemia and with different cold preservation time in liver transplantation. Methods The clinical data of 154 patients who received liver transplantation at the First Affiliated Hospital of Sun Yat-sen University from January 2006 to December 2007 were retrospectively analyzed. The warm ischemia time of the liver grafts obtained from the non-heart-beating donors was within 10 minutes. According to cold perservation time of the liver grafts, patients were divided into 3 groups ： the cold preservation time of the liver grafts was within 8 hours, 8-12 hours and above 12 hours in group Ⅰ （ n = 58） , group Ⅱ （n = 62） and group Ⅲ （n = 34）, respectively. The peak level of alanine aminotransferase （ALT）, primary graft dysfunction （PGD） after liver transplantation, acute rejection response, biliary complications, vessel complications, perioperative infections and the survival of liver grafts and recipients among the 3 groups were analyzed via chi-square test, t test and variance analysis. Results No PGD was detected in the 3 groups after liver transplantation. All patients were followed up for 8-32 months. The peak level of ALT, incidence of infection and biliary complication, survival of liver grafts and recipients were （482 ± 357 ） U/L, 12% （7/58）, 12% （7/58）, 86% （50/58） and 88% （51/58） in group Ⅰ, and were （1274 ±608） U/L, 29% （10/34）, 26% （9/34）, 68% （23/34） and 71% （24/34） in group Ⅲ, with significant difference between the 2 groups （t = 5.23, X2 =4. 28, 6. 77, 4.51, 4. 28, P 〈0.05）. The peak level of ALT in group Ⅱ was （953 ±424）U/L, which was significant higher than （482 ± 357 ） U/L in group I （ t = 4.76, P 〈 0.05 ）. Conclusions Liver grafts with a warm ischemia time shorter than 10 minutes could tolerate the injury caused by cold preservation with the maximum time of 12 hours. The incidences of biliary complications and postoperative infections are significantly increased and the survivals of liver grafts and recipients are decreased when the cold preservation time exceeds 12 hours.