心脏死亡供者供肺移植三例报告

Lung transplantation from donor of cardiac death in China （report of 3 cases）

目的总结心脏死亡供者供肺获取以及应用于临床肺移植的经验。方法共进行3例心脏死亡供者供肺获取及肺移植。3例供者平素健康，因发生严重颅脑外伤或脑肿瘤，经严格医学检查后均被明确判定为脑死亡，并被确定为潜在心脏死亡供者。供者的近亲亲属均知情同意心脏死亡器官捐献，临床评估供肺良好，供者在停止呼吸机，心脏停跳5min后，确定为心脏死亡，并在全身麻醉下切取供肺。3例受者术前淋巴细胞毒交叉配合试验均为阴性，供、受者灿如血型相同，身高相近，体重相差均在20％以内，胸腔大小匹配。结果利用3例心脏死亡供者供肺成功进行了2例双肺移植和1例单肺移植，3例供肺的热缺血时间分别为23、27和32min。3例受者手术顺利，在ICU的监护时间分别为31、18和26d，术后肺功能得到极大改善，例1和例2分别于术后30和19d发生急性排斥反应，经皮质激素冲击治疗后好转，3例受者均未发生感染等并发症，随访期间生活质量良好。结论在现有条件下，严格按《中国心脏死亡器官捐献工作指南》开展心脏死亡器官捐献应用于临床肺移植的工作，正确维护好潜在心脏死亡供者，在全面评估供肺质量的前提下，心脏死亡供肺可作为肺移植的主要供肺之一。

Objective To summarize the clinical experience of cardiac death donor. Methods The lungs from donation after cardiac used for lung transplantation. The donors suffered from severe harvesting and using the lungs of death （DCD） were harvested and craniocerebral trauma or brain neoplasms and were identified after cardiac death post declaration of brain death. Written consent about DCD was obtained from the consanguinities. The donor lungs were harvested after clinical evaluation of donors with considerable function and after the determination of DCD. The preoperative lymphoeytotoxic cross match test was negative, ABO blood type was compatible, and the donors were all suitable for the transplant procedure. Results Two bilateral lung transplantations and one single lung transplantation were performed, with the warm ischemic time being 23, 27, and 32 rain, respectively. The operative course was uneventful. The ICU stay was 31, 18, and 26 days respectively, with dramatic improvement of pulmonary function postoperatively. Acute rejection occurred in two cases, which was treated with bolus of corticoids. There were no infection in our 3 patients, and the life quality was satisfactory during the follow-up period. Conclusion The lung from DCD may be one of the available resources used for lung transplantation on the basis of efficient management of the potential donors and clear evaluation of the donors.