冷缺血时间对脑-心双死亡供肝移植术后早期肝功能的影响

The impact of cold ischemic time on early graft liver function after liver transplantation using cadaveric donors with brain plus cardiac death

目的探讨冷缺血时间（cold ischemic time，CIT）对脑-心双死亡（donation after brain plus cardiac death，DBCD）供肝肝移植术后早期肝功能的影响。方法前瞻性地评估DBCD供肝肝移植术后1周肝功能的变化，通过与心脏死亡（donation after cardiac death，DCD）供肝肝移植比较，分析CIT与术后1周肝功能受损程度的相关性以及早期肝功能受损程度与术后早期并发症的相关性。结果DBCD组CIT时间较DCD组明显缩短（4．6±1．8h比7．9±3．7h，P=0．002）。DBCD组术后第1、3天ALT明显低于DCD组（535±227IU／L比864±386IU／L，P=0．026；254±94IU／L比519±165IU／L，P=0．003），相应的DBCD术后早期相关并发症发生率也明显低于DCD组（26．7％比57．1％，P=0．03）。CIT时间长短与术后1周肝功能受损程度明显正相关（r2=0．914，P〈O．001），而术后早期肝功能的受损程度则与术后早期并发症的严重程度明显正相关（rs=0．791，P=0．002）。结论DBCD供肝肝移植具有较短的冷缺血时间，移植术后早期肝功能受损程度明显减轻，术后早期相关并发症也相应减少。DBCD是当前较为理想的供肝肝移植治疗模式。

Objective To evaluate the impact of cold ischemic time （CIT） on early graft liver function after liver transplantation using cadaveric donors with brain plus cardiac death （DBCD）. Methods The CIT and graft liver function were collected prospectively. The impact of CIT on early graft liver function after liver transplantation in DBCD was compared with donors with cardiac death （DCD）. The relationship between early graft liver function and post-transplantation early complications were also studied. Results The CIT in the DCD group was significantly longer than the DBCD group （7.9±3.7 h vs. 4.6±1.8 h, P=0. 002）. The levels of ALT in the DCD group on day 1 and 3 were higher than the DBCD group （864!386 IU/Lvs. 535±227 IU/L, P=0.026; 519±165 IU/L vs. 254±94 IU/L, P=0. 003）. Early complications after liver transplantation in the DCD group were also higher than the DBCD group （57.1% vs. 26.7%, P=0.03）. The duration of CIT correlated with the degree of injury in early graft liver function after liver transplantation （r2 = 0. 914, P〈0. 001）. Obvious injury in early graft liver function resulted in serious early complications （rs=0. 791 ,P=O. 002）.Conclusions These findings suggest that liver transplantation with DBCD was superior to DCD due to the shorter CIT and milder injury to early graft liver function.