不同冷保存时间热缺血供肝在肝移植中的应用(英文)

Warm ischemia liver grafts tolerance to varied cold ischemia time for liver transplantation

背景:目前国内临床肝移植供肝的主要来源仍然是无心跳供体供肝,国外近年来也越来越多地使用无心跳供体供肝,但无心跳供体供肝这类经历了热缺血的供肝能够耐受冷保存的安全时限尚没有统一标准,也鲜有这方面的临床报道。目的:评价不同冷保存时间的热缺血供肝在临床肝移植中的应用安全性及疗效。设计、时间及地点:随机对照观察,于2006-01/2007-12在中山大学附属第一医院器官移植中心完成。对象:无心跳供体供肝热缺血时间在10min内的肝移植病例154例。方法:根据冷保存时间不同分为3组,8h内组58例,8～12h组62例,13～16h组34例。供肝按供体分配原则按随机数字表法分配给3组患者,移植后采用相同的免疫抑制方案。主要观察指标:比较3组患者肝移植后谷丙转氨酶峰值、原发性移植肝无功能、急性排斥反应、胆道并发症、血管并发症、感染,以及移植肝存活和受体存活情况的差异。结果:随访8～32个月,3组患者移植后均未发生原发性移植肝无功能。8～12h组患者移植后仅谷丙转氨酶峰值高于8h内组(P<0.05),其余治疗两组比较差异均无显著性意义(P>0.05)。与8h内组患者比较,13～16h组患者的移植后谷丙转氨酶峰值、感染发生率和胆道并发症发生率显著升高(P<0.05),移植肝存活率和受体存活率显著降低(P<0.05)。结论:热缺血时间在10min内的无心跳供体供肝能够耐受12h的冷保存损伤,超过此时限,移植后胆道并发症和感染的发生率明显升高,移植肝存活率和受体存活率明显降低。

BACKGROUND：Nowadays,liver grafts for transplantation are clinically sourced from non-heart-beating donors.Moreover,there is still no uniform determination of safe time limit points for non-heart-beating donor liver in warm ischemia and cold preservation.OBJECTIVE：To evaluate the application safety and curative effects of warm ischemia liver graft affected by varied cold ischemia time （CIT） in liver transplantation.DESIGN,TIME AND SETTING：A randomized controlled observation was performed in the Organ Transplantation Center,First Affiliated Hospital of Sun Yat-sen University between January 2006 and December 2007.PARTICIPANTS：154 cases who underwent non-heart-beating liver transplantation were included in this study.All liver grafts involved had a warm ischemia time（WIT） less than 10 minutes.METHODS：All cases were assigned into 3 groups according to CIT：group Ⅰ （CIT 8 hours,n=58）,group Ⅱ （CIT 8-12 hours,n=62）,and group Ⅲ （CIT 13-16 hours,n=34）.The liver grafts were randomly allocated for the patients.Following liver transplantation,the same immunosuppression protocol was employed for each group.MAIN OUTCOME MEASURES：Following surgery,peak level of alanine aminotransferase （ALT）,primary graft dysfunction （PGD） after liver transplantation,acute rejection response,biliary complications,vessel complications,perioperative infections,graft and recipient survival rate were compared among 3 groups.RESULTS：Follow-up time was 8-32 months.No PGD was detected in all 154 cases.Group Ⅱ showed postoperative ALT peak levels significantly higher than group Ⅰ （P〈0.05）.There was no significant difference between groups Ⅰ and Ⅱ in terms of acute cellular rejection,perioperative infection,biliary complication,vessel complication,graft survival rate,and recipient survival rate （P〉0.05）.Compared with group Ⅰ,the group Ⅲ exhibited significantly increased postoperative ALT peak level,biliary complications,and perioperative infections,and significantly decreased graft and recipient survival rate （P〈0.05）.CONCLUSION：Non-heat-beating-liver grafts with less than 10 minutes of warm ischemia can tolerance 12 hours of cold ischemia.More than 12 hours,postoperative liver transplantation complications ascend and,contradictorily,graft and recipient survival rate descend.