脑死亡来源供肝肝移植9例临床分析

Liver transplantation using grafts from brain dead donors:a report of 9 cases

目的总结使用脑死亡来源供肝肝移植的临床经验,初步分析脑死亡来源供肝应用于临床的安全性。方法2006年1月至2007年12月我院器官移植科共实施9例脑死亡来源供肝肝移植。供体年龄16～43岁,死于颅脑外伤7例,死于脑血管意外2例,器官切取前平均动脉压(105±5.2)mmHg(1mmHg=1.333kPa)(6例需使用升压药物),肝功能检测丙氨酸转氨酶(175±40)U/L,天冬氨酸转氨酶(180±46)U/L,总胆红素(40±8.6)mmol/L。受者年龄(48.6±10.1)岁,男性8例,女性1例;术前诊断为肝硬化5例,肝癌4例,术前MELD评分(27.6±6.7)分。结果供肝冷缺血时间为(7.4±2.8)h,所有患者手术顺利。1例于术后7天死于肾功能衰竭。8例受者康复出院并随访6～24个月,1例于术后24个月死于肿瘤复发,其他并发症发生包括急性排斥反应2例,胆道狭窄并感染1例,胆道缺血1例,肺部感染1例。结论按照我们选择脑死亡供肝的原则,肝移植受者术后近期及中期预后良好,具有临床应用前景。

Objective To study the short and medium-term outcomes of liver transplant patients receiving liver grafts from brain death donors and summarize the clinical experience of using brain death liver grafts. Methods The clinical data of 9 cases of liver transplant recipients with brain death liver grafts in the Transplant Center, First Affiliated Hospital of Sun Yat-sen University were retrospectively studied. The donors aged from 16 to 43 years, of which 7 died from brain trauma and 2 from cerebrovascular accident. Mean arterial pressure (MAP) of the donors was (105±5.2) mmHg (1 mmHg=1.333 kPa)before organ harvesting, 6 of which needed vasopressors. Their liver function was (175±40)U/L of aspartate aminotransferase, (180±46)U/L of alanine aminotransferase, and (40±8.6) mmol/L of total bile acid. The recipients aged (48.6±10.1) years, 5 with liver cirrhosis and 4 with hepatocellular carcinoma. Their MELD scores before transplantation was 27.6±6.7. Results All operations were successful with a mean cold ischemia time of (7.4±2.8) hours. One patient died of renal failure on the 7th day post-transplantation, the other 8 patients recovered well and were followed up for 6 to 24 months after discharge. One patient died from tumor recurrence in the 24th month after operation. Other complications included acute rejection in 2 cases, biliary anastomosis stenosis combining infection in 1 case, biliary track ischemia in 1 case, and lung infection in 1 case, which were all controlled by conservative treatment. Conclusions The short and medium-term outcomes of the recipients and grafts are acceptable, which indicates that brain death liver grafts are suitable for liver transplantation in our country.