心脏死亡器官捐献边缘供肝肝移植三例临床分析

DCD marginal donor for liver transplantation: three cases of clinical analysis

目的探讨心脏死亡器官捐献(DCD)边缘供肝应用的可行性。方法回顾性分析吉林大学白求恩第一医院肝移植中心2015年4月至5月施行的3例边缘供肝肝移植供、受者临床资料。结果 3例边缘供肝供者均为男性,包括61岁老年供者供肝1例,重度脂肪变性(肝细胞气球样脂肪变>65%)供肝1例,冷缺血时间延长(15.7 h)1例。均实施中国三类标准器官捐献。老年供肝肝移植受者术后肝功能恢复良好,未出现排斥反应。重度脂肪变性供肝肝移植受者术后肝功恢复差,术后1周因移植肝原发性无功能再次行肝移植。冷缺血时间延长供肝肝移植受者术后恢复顺利,术后10 d发生轻度急性排斥反应,将他克莫司由2.0 mg(2次/d)调整为2.5 mg(2次/d),肝功能恢复良好。结论在综合评估供肝状况及合理匹配受者的前提下,边缘供肝能够安全使用,并能取得良好的临床效果。老年供肝可以匹配终末期肝病模型评分低的老年受者;冷缺血时间延长供肝可通过增加灌注次数以适当缓解术后肝功能恢复延迟情况;重度脂肪变性供肝仍应谨慎使用,要综合其他影响供肝的因素及受者状况来决定。

Objective To explore the feasibility of using donation after cardiac death（ DCD）marginal donors for liver transplantation. Methods From April 2015 to May 2015,3 cases of DCD marginal donors for liver transplantation were carried out in the Liver Transplantation Center,the First Bethune Hospital of Jilin University. Results The general outcomes of liver transplantation recipients using marginal donors were satisfied. The 3 marginal donors were male,Chinese Ⅲ DCD ethical standard,including a 61-year-old donor,a severe fatty liver donor,and a cold ischemia time of 15. 7hours donor. The elder donor liver transplantation recipient recovered smoothly without rejection; The severe fatty liver donor liver transplantation recipient recovered poor,got hypohepatia and primary nonfunction,underwent liver retransplantation 1 week after the first transplantation; cold ischemia time of 15. 7 hours donor liver transplantation recipient recovered smoothly with a rejection 10 days after the operation,we increased Tacrolimus Capsules from 2. 0 mg to 2. 5 mg（ twice per day）,then the recipient recovered smoothly. Conclusions It＇ s feasible to use DCD marginal donors for liver transplantation,with integrated assessment liver function and fairly match organs with recipients. Elder liver transplantation recipient with lower MELD score should match elderly donors; increased amount of UW could reduce the opportunity of long cold ischemia time delayed recovery of liver graft; the severe fatty liver should be cautiously used.