公民逝世后器官捐献肝移植94例的单中心临床分析

Clinical analysis of 94 cases of liver transplantation with donation after citizens death in a single center

目的总结公民逝世后器官捐献（DCD）的单中心治疗经验，探讨供者选择对受者早期预后的影响。方法回顾性分析2010年10月至2014年12月单中心94例DCD供者和受者的临床资料。结果94例中，高钠血症供者26例，血清钠为155～160mmol／L和160～180mmol／L者分别有15例和11例，其术后早期移植肝功能不全发生率分别为20．0％和18．2％，与正常血清钠供者相应受者（移植肝功能不全发生率为22．1％）相比较，发生率的差异无统计学意义（P=0．861，P=0．772）。脂肪肝供肝15例（轻度14例，中度1例），术后早期移植肝功能不全发生率为26．7％，与无脂肪肝供肝（术后早期移植肝功能不全发生率为20．3％）相比较，发生率的差异无统计学意义（P=0．832）。6例儿童供肝成人受者，术后血管并发症与胆道并发症发生率分别为16．7％和16．7％，与成人供肝术后（血管并发症和胆道并发症发生率分别为4．8％和19．3％）相比较，发生率的差异无统计学意义（P=0．301，P=1．000）。供肝冷缺血时间〉10h的相应受者术后早期移植肝功能不全发生率为25．0％，供肝冷缺血时间≤10h的相应受者术后早期移植肝功能不全发生率为20．2％，差异无统计学意义差异（P=0．880）。对于使用多巴胺和多巴胺联合去甲肾上腺素维持血压的供者，相应受者术后早期移植肝功能不全的发生率为18．3％和26．7％；对于没有使用药物维持血压的供者，相应受者术后早期移植肝功能不全的发生率为26．3％，发生率的差异无统计学意义（P=0．325，P=0．640）。术后1、3年移植物及受者存活率分别为92．2％和85．7％。结论综合评估供者、受者整体情况，谨慎地拓宽DCD在高钠血症供者、脂肪肝供肝、儿童供肝成人受者、冷缺血时间等方面的标准，对受者早期预后未见明显不良影响。

Objective To summarize the experience of liver transplantation with donation after citizens death （DCD）, and explore the influence of donor selection on the early prognosis of recipients in single center. Method The clinical data of 94 cases of donors and recipients from October 2010 to December 2014 were analyzed retrospectively. Result The hypernatremia was observed in 26 cases. The levels of blood sodium in 155-160 mmol/L and 160-80 mmol/L were found in 15 cases and 11 cases with the early graft dysfunction rate postoperation being 20. 0% and 18. 2%, respectively. There was no statistically significant difference as compared with that in normal serum sodium （22. 1% ; P = 0. 861, and P = 0. 772）. Steatosis liver was found in 15 donors （mild in 14 cases, and moderate in 1 case） with the rate of early graft dysfunction being 26. 7%. There was no statistically significant difference compared to that without steatosis liver after transplantation （20. 3%; P = 0. 832）. Six cases of liver transplantations from children to adults were accomplished, and the incidence of the vascular and biliary complications was 16. 7% and 16. 7%, respectively. There was no statistically significant difference compared with that in adults to adults liver transplantation （4. 8% and 19. 3%; P = 0. 301, P = 1. 000）. The rate of early graft dysfunction with cold ischemia time 10 h and 410 h was 25.0% and 20. 2% respectively （P = 0. 880）. The rate of early graft dysfunction by using dopamine alone and dopamine combined with norepinephrine to maintain blood pressure was 18. 3% and 26. 7%, respectively, which was not significantly different from that without using drugs after operation （26. 3%; P = 0. 325, P = 0. 640）. The 1- and 3-year survival rate of grafts and patients after operation was 92. 2% and 85.7%, respectively. Conclusion There was no undesirable influence on early prognosis postoperation to prudently extend the standards of DCD in donors with high serum sodium, steatosis liver, children liver to adult recipients, cold ischemia time, etc on the basis of comprehensively evaluating the status of donors and recipients.