脑-心双死亡标准器官捐献供肝评估的经验总结及临床选择标准的探讨

The experience of donor from donation after brain death and cardiac death and the clinical donor selection criteria

目的总结公民逝世后脑-心双死亡标准器官捐献（DBCD）供肝的评估经验，并探讨DBCD供肝临床选择的标准。方法回顾性分析广东省佛山市第一人民医院自2011年11月至2014年10月期间实施DBCD供肝30例的供、受者资料。结果30例DBCD供者的年龄为（35±12）岁（15-59岁）；在供者肝脏获取前所检测的AST中位数为73U／L，95％可信区间为45～313U／L；ALT中位数为62U／L，95％可信区间为35-221U／L；血清Na＋中位数为146mmol／L，95％可信区间为146~155mmol／L。供肝的热缺血时间为（9，0±4．9）min，冷缺血时间为（5．4±2．1）h。移植后受者发生早期移植肝功能不全10例，胆管狭窄4例，胆漏2例，肝动脉夹层动脉瘤1例，移植后均未出现原发性移植肝无功能。2例受者死亡，术后1年移植物及受者存活率均为95．70（22／23），术后2年移植物及受者存活率均为93．3％（14／15）。结论DBCD供肝的临床选择应综合参考供者年龄、肝功能、血清Na＋、供肝热缺血时间、冷缺血时间、脂肪变性情况，及供、受者乙型肝炎血清学检查结果和血型配型情况。对DBCD供肝的临床情况进行早期评估，谨慎的扩大供肝临床选择的标准，可有效扩大器官来源，保障移植效果。

Objective To summarize the experience of donor evaluation from donation after brain death and cardiac death （DBCD） and discuss the clinical donor selection criteria. Method The clinical data of 30 patients with liver transplantation, receiving donation after brain death and cardiac death from November 2011 to October 2014 were retrospectively analyzed. Result In this dataset, the age of donors was 15-59 years old with a mean of 35 ± 12; the median aspartic transaminase （AST） and alanine aminotransferase （ALT） levels of donors before procurement were 73 U/L and 62 U/L respectively with the 95% confidence interval being 45-313 U/L and 35-221 U/L respectively. The median serum sodium of donors was 146 mmol/L with the 95% confidence interval being 146-155 mmol/L. The mean warm ischemia time of donors was 9. 0 ± 4. 9 min, and the mean cold ischemia time was 5.4 ± 2. 1 h. There were 10 cases of initial poor function, 4 cases of biliary stricture, 2 cases of biliary leak and 1 case of hepatic artery dissection aneurysm in 30 cases. No cases had primary non- function. Two recipients died. The 1- and 3-year graft and patient survival rate was 95.7%, 95.7%, 93.3% and 93.3% respectively. Conclusion Choosing DBCD donors should not only take into donor clinical variables account as follows., age, liver function, warm ischemia time, cold ischemia time, steatosis, also be attention to hepatitis B serology and blood type of donor and recipient. It will increase organ donations and obtain better transplant outcomes as a result of evaluating organ donors early and extending the clinical donor selection criteria prudently.