公民逝世后器官捐献肝移植单中心临床疗效分析及初步经验

Single-center analysis on curative effect of liver transplantation from organ donation by citizens after death and initial experience

目的探讨公民逝世后器官捐献供肝肝移植的疗效及初步经验。方法回顾性分析2012年7月至2014年4月在中山大学附属第三医院实施公民逝世后器官捐献供肝肝移植的63例供者及63例受者临床资料。所有供者家属及受者均签属知情同意书,符合医学伦理学规定。供者男50例,女13例;年龄3～57岁,中位年龄29岁;根据中国心脏死亡器官捐献分类标准,属于中国一类27例,中国二类32例,中国三类4例。受者男53例,女10例;年龄6～74岁,中位年龄42岁。采取加强发现潜在供者的培训、积极维护潜在供者器官功能、快速规范化器官获取技术等措施获取供肝。观察肝移植受者围手术期情况及随访期间预后。结果 63例受者均顺利接受肝移植。ICU中位监护时间3（2～7）d,术后住院时间28（25～40）d。围手术期死亡5例,其中2例死于原发性移植肝无功能,3例死于感染和多器官功能衰竭。术后发生动脉吻合口狭窄1例,缺血型胆管炎1例,胆道吻合口狭窄2例。受者术后随访时间8～34个月,随访期间死于肿瘤复发、转移2例;其他受者肝功能恢复顺利,预后良好。结论合理有效地利用公民逝世后器官捐献供肝可扩大供肝来源,受者近期疗效良好。加强医师对发现潜在供者的培训、积极维护潜在供者器官功能、快速规范化器官获取技术是保障供肝质量的重要因素。

Objective To discuss the curative effect and initial experience of liver transplantation（LT） from organ donation by citizens after death. Methods Clinical data of 63 donors and 63 recipients who underwent LT from organ donation by citizens after death in the Third Affiliated Hospital of Sun Yat-sen University from July 2012 to April 2014 were analyzed retrospectively. The informed consents of donor family members and recipients were obstained and the ethical committee approval had been received. Among the donors, 50 were males and 13 were females with the age ranging from 3 to 57 years old and the median of 29 years old. According to the category for China organ donation after cardiac death, 27 donors were donation after brain death（DBD, C-Ⅰ）, 32 were donation after cardiac death（DCD, C-Ⅱ）, and 4 were donation after brain and cardiac death（DBCD, C-Ⅲ）. Among the recipients, 53 were males and 10 were females with the age ranging from 6 to 74 years old and the median of 42 years old. In order to obtain applicative donor liver, training on discovering potential donors was strengthened, organ function of potential donors was actively maintained and fast, normalized organ procurement skills were carried out. The conditions during the perioperative period and the prognosis during the follow-up period of the recipients were observed. Results All the 63 recipients underwent LT successfully. The median ICU stay was 3（2-7） d and the postoperative hospital stay was 28（25-40） d. Perioperative death was observed in 5 cases, in which 2 cases died of primary graft failure and the other 3 cases died of infection and multiple organ failure. After operation, 1 patient suffered from arterial anastomotic stenosis, 1 suffered from ischemic cholangitis and 2 suffered from biliary anastomotic stenosis. The recipients were followed up for 8-34 months. Two cases died of tumor recurrence and metastasis. The liver function of the rest recipients recovered successfully with good prognosis. Conclusions Reasonable and effective use of organ donation by citizens after death can expand the sources of donor liver. The recent curative effect of recipients is good. Strengthening of training on discovering potential donors, active maintenance of organ function of potential donors and fast, normalized organ procurement skills are important factors to ensure the quality of donor liver.