中国公民逝世后肝肾器官捐献及捐献器官临床应用

Clinical application of liver and kidney organ donation and donor organ after Chinese citizens death

目的探讨中国公民逝世后器官捐献肝肾器官移植的临床疗效及初步经验。方法回顾性分析成功实施的8例中国公民逝世后器官捐献供者和21例受者临床资料、受者围手术期情况及预后等。结果8例供者中,属于中国二类1例,中国三类7例。21例受者中,5例接受肝移植、15例接受肾移植和1例接受肝肾联合移植,手术均顺利完成。肝移植受者围手术期间,1例死于术后出血、感染和多器官功能衰竭;术后随访时间4-25个月,生存受者均预后良好。肾移植受者围手术期间,供者血肌酐（Cr）正常的5例,供给10例受者中2例发生移植肾功能延迟恢复（DGF）,发生率20.0%;供体Cr（≥133μmol/L）异常的3例,供给5例受者4例发生DGF,发生率80.0%;术后随访时间5-42个月,7例发生肺部感染,2例出现肾功能不全,其他受者恢复顺利,预后良好。1例肝肾联合移植受者恢复良好,未出现重大手术及手术相关并发症。结论合理有效地利用中国公民逝世后器官捐献的供器官、加强供者术前评估与功能维护以及减少热缺血和冷缺血时间,既扩大了供器官来源,又能获得满意的移植效果。

Objective To investigate the clinical effect of organ donation after Chinese death and the initial experience of liver and kidney transplantation（ LT and KT）. Methods Clinical data of 8 donors and 21 recipients who underwent LT,KT,LT and KT from organ donation by Chinese citizens after death were analyzed retrospectively.Results In the 8 donors,1 was donation after cardiac death（ DCD,C-Ⅱ）,and 7 were donation after brain and cardiac death（DBCD,C-Ⅲ）. With these donated organs,5 cases of LT,15 cases of KT,1 case of LT and KT,and all the recipients underwent successfully. Perioperative period of LT recipients,1 case died of postoperative bleeding,infection and multiple organ failure. The recipients were followed up for 4-25 months,and all the existing recipients recovered successfully with good prognosis. Perioperative period of KT recipients,Cr was normal of the 5 cases donors,delayed graft function（ DGF） occurred in 2 of 10（ 20.0%） recipients. Cr（≥133 μmol /L）was abnorm alities of the 3 donor cases,DGF occurred in 4 of 5（ 80. 0%） recipients. The recipients were followed up for 5-42 months,pulmonary infection occurred in 7 recipients and 1 suffered from renal insufficiency. The kindey function of the rest recipients recovered successfully with good prognosis. Combined liver and kidney transplantation recipients recovered successfully and none suffered major surgical complications. Conclusion Reasonable and effective use of organ donation by chinese citizens after death can strengthen the preoperative evaluation and functional maintenance of donors and decrease warm and cold ischemia time. It can not only expand the sources of donor organs,but also obtain the satisfactory results.