心脏死亡供者供肝移植三例报告

Liver transplantation from donation after cardiac death （report of 3 cases）

目的总结心脏死亡器官捐献（DCD）供肝移植的临床经验。方法共有7例心脏死亡器官捐献者，原发病包括脑出血3例（其中1例合并高血压），颅脑外伤2例，脑基底动脉闭塞1例，颅脑肿瘤（脑胶质瘤Ⅱ级）卒中1例。依据《中国心脏死亡器官捐献指南》实施捐献，采用腹部器官联合快速切取方法切取器官。受者的原发疾病为乙型肝炎后肝硬化（失代偿期）和原发性肝癌。术后预防感染，根据凝血酶原时间采取抗凝治疗，采用他克奠司＋吗替麦考酚酯＋泼尼松预防排斥反应。结果有3例供者分别因合并酒精性肝硬化、家属拒绝捐献肝脏和肝脏热缺血时间超过30min而未能切取肝脏，1例由红十字会协调至其他移植中心，3例完成肝移植。供肝热缺血时间分别为7．5、9和10min，冷缺血时间为4．5、8．2和6．5h。受者术后随访2～9个月，术后近期无原发性移植物无功能，未发生血栓形成和排斥反应等并发症，肝功能恢复良好，均顺利出院。结论DCD供肝移植的近期效果良好，选择可控制的中国三类供者、中高度风险的uw评分以及较短的热缺血时间是保障肝移植成功的重要因素。

Objective To summarize our experience in the liver transplantation from the donation after cardiac death （DCD）. Methods The livers from three DCD donors （2 cases of brain trauma and 1 case of cerebral hemorrhage） were harvested according to the Guidelines for Donation after Cardiac Death in China. These grafts were orthotopically transplanted into three recipients including 2 cases of decompensative hepatic cirrhosis and 1 case of primary liver cancer. The warm ischemic time ranged from 7. 5 to 10 rain and the cold ischemic time was 4. 5, 8. 2 and 6. 5 h respectively. Postoperative immunosuppressive regimens included prednisone, FK506 and myeophenolate mofetil （MMF）. Antibiotics and anticoagulatants were used accordingly. Results All of the 3 recipients obtained normal liver function within 3 weeks since the grafts were implanted without PNF, thrombosis and rejection. No postoperative complications occurred in 3 recipients during the follow-up period of 2 to 9 months with normal liver function. Conclusion The liver transplant from DCD donor showed good results in our center. Chinese group Ill of DCD donor, UW score above the middle level and the short warm ischemic time are three keys ensuring the success of the liver transplant from DCD donors.