单中心心脏死亡和脑死亡供肺肺移植临床经验总结

Lung transplantation from donor of cardiac death and donation after brain death in one centre Ⅲ ： 4 cases report

目的总结单中心脑死亡器官捐赠（DBD）和心脏死亡器官捐赠（DCD）的供肺获取以及肺移植的临床经验。方法11例潜在器官捐献供者进行了术前评估，所有供者均进行痰培养、床旁支气管镜、胸部X线片及血液气体分析等检查。11例供者中，6例为DCD供者，5例为DBD供者。1例DCD和2例DBD供者因两肺广泛炎症浸润，氧合指数差未行供肺获取；1例DCD供者因心跳停止时间过长未行供肺获取；其余7例临床评估供肺良好，按照临床器官捐赠相关规定流程，在气管插管机械通气下完成供肺获取。7例供、受者术前淋巴细胞毒交叉配合试验均为阴性，供、受者ABO血型相同，供肺大小匹配。结果7例肺移植均在体外膜肺氧合辅助下完成，包括5例双肺移植和2例右侧单肺移植，受者手术顺利。1例术后并发严重感染，术后39d死亡；1例术后第9天死于多器官功能衰竭。2例分别于术后30d、19d并发急性排斥反应，治疗后好转。3例术后无严重并发症，恢复顺利，肺功能得到极大改善，出院后接受长期随访，术后平均存活23．3个月（3～51个月）。结论应该严格按照临床器官捐献相关规定的要求进行器官捐赠工作。在全面评估供肺质量的前提下，DCD和DBD供肺肺移植的效果可靠。

Objective To summarize the clinical experience of harvesting and using the lungs from donation after brain death （DBD） and donation after cardiac death （DCD, Maastricht category IV） in China. Methods Eleven potential DBDs and DCDs were evaluated by our transplant group preoperatively, including 6 cases of DCDs and 5 cases of DBDs, and all of them received the tests of sputum culture bedside bronchoscopy, chest X rays, and blood gas analysis. After clear evaluation, 1 case of IXED and 2 cases of DBD were discharged from the group for bilateral inflammatory infiltration and poor oxygenation index, and one case of DCD was precluded due to long warm ischemic time （〉 60min）. The donor lungs from remaining 7 cases were harvested successfully after the declaration of brain death or cardiac death. The preoperative lymphocytotoxic cross match test was negative, ABO blood types were compatible, and the donors were all suitable for the transplant procedure. Results Seven lung transplants were performed successfully under ECMO support, including 5 cases of bilateral lung transplantation and 2 cases of single lung transplantation. One patient was complicated with severe infection and died of sepsis on postoperative day （POD） 39, and one was succumbed to multiple organ failure. Two patients suffered of acute rejection on POD 30 and POD 19, respectively, and obtained improvements by bolus steroid therapy. The remaining 3 patients all recovered uneventfully. During a follow-up period, all the patients lived an active life style with high quality of life. The mean survival time was 23. 3 months （3-51 months）. Conclusion The DCD and DBD may be one of the available donor resources for lung transplantation after efficient management of the potential donors and detailed preoperative evaluation in China.