活体小肠移植术供体的选择及处置

Selection and management of donors for the living-related small bowel transplantation

目的探讨活体小肠移植供体的选择原则和处置。方法对我国首次成功的2例临床活体小肠移植进行回顾性研究。受体均为短肠综合征患者。患者1由其父供末端回肠150cm;患者2接受其母亲末端回肠160cm。两供体的组织配型HLA与各自的受体半相符,ABO血型相同。供体进行严格的体检,肠镜及钡剂造影确定小肠的长度合适,D-木糖吸收实验证实吸收功能正常,血管造影示肠系膜血管分布正常。术前严格肠道准备,术中细致取肠及运用4℃UW液进行重力灌洗。供体术后常规处理。结果两名供体术后恢复顺利,无手术并发症,肠道吸收功能恢复正常。受体1目前已经健康存活24个月,正常进食,生活自理,体重增加20kg;受体2已健康存活5个月。2例均出现了1次急性排斥反应,但经激素冲击治疗后得到控制。结论选用组织相容性好、健康标准体重的亲体作为供体,术前供体的充分准备、术中细致操作、术后细心管理,是保证移植小肠存活和供体手术安全的关键。

Objective To elucidate the principles of selection and perioperative management of donors for the living related small bowel(SB) transplantation. Methods The first case was a 18 year old boy with short gut syndrome and underwent the living related small bowel transplantation with the graft(150 cm distal ileum) taken from his healthy father(44 year old). The second case, short gut syndrome as well, was a 14 year old boy with the graft(160 cm distal SB) taken from his healthy mother (49 year old). The donors and the recipients were matched on three HLA loci ( HAL A and B and DR), and in same ABO blood groups typing. For the donors, preoperative angiogram of superior mesenteric artery showed a normal vascular distribution pattern to the SB, and small bowel enema examination showed normal length of SB. D xylose absorption test confirmed normal absorption function.Results Up to present, the first recipient enjoyed good health and TPN independent for 24 months. The second recipient was in good condition after the transplant. Both recipients suffered with 1 episodes of acute rejection and were controlled by steroid pulse therapy and increased trough level for tacrolimus (FK506). The postoperative recovery of donors were uneventful and they suffered no untoward side effects from the resection. They were discharged on postoperative day 12 respectively. Conclusion Good results can be achieved with strict donor selection and proper perioperative management in the living related small bowel transplantation.