儿童器官捐献供肝婴儿肝移植术后早期肝动脉血流变化的临床观察

Hemodynamics of hepatic artery in infant recipients at early postoperative stage after DCD liver transplantation

目的总结儿童器官捐献供肝婴儿肝移植术后早期移植肝动脉血流变化的临床特点，探讨术后早期移植肝动脉闭塞的可能原因。方法回顾性分析2014年1月至2015年7月儿童供肝婴儿肝移植临床病例23例，搜集每例受者术后早期移植肝多普勒超声检查结果，分析术后早期肝动脉闭塞患儿的临床特点及移植肝脏血流动力学特征。结果婴儿肝移植术后早期肝动脉闭塞的发生率为26．1％（6／23），大多数首先表现为肝动脉分支闭塞，后进展为肝动脉主干闭塞，且所有患儿均于闭塞发生后（14．7±2．9）d出现代偿性肝动脉侧枝血流。按肝动脉闭塞进行分组，肝动脉闭塞组的供肝大小不匹配率显著高于肝动脉未闭塞组，分别为83．3％（5／6）、23．5％（4／17），组间差异有统计学意义（P=0．018）。按供肝大小匹配情况分组，供肝过小组、供肝大小匹配组及供肝过大组的每100g肝组织门静脉血流量分别为（316．91±114．96）ml／min、（158．20±66．10）ml／min、（110．09±33．46）ml／min，组间差异有统计学意义（P〈0．01）。结论儿童供肝婴儿肝移植术后早期肝动脉闭塞在供肝大小不匹配的受者中发生率显著增高，在供肝过小的受者，门静脉高灌注导致的代偿性肝动脉血流减少，即肝动脉缓冲效应，可能是该组患儿肝移植术后早期发生肝动脉闭塞的潜在机制，而接受过大供肝患儿的肝动脉闭塞发生机制有待于进一步研究。

Objective To summarize the hemodynamics of hepatic artery in infant recipients at early postoperative stage after DCD liver transplantation, and to explore the possible factors associated with early postoperative hepatic artery occlusion （HAO）. Method Clinical data of all infant recipients of DCD liver transplantation performed by a single surgical team in our hospital from January 2014 to July 2015 were retrospectively analyzed by reviewing medical charts, with emphasis on Doppler ultrasonic results of graft liver at early postoperative stage. Clinical characteristics of graft hepatic artery hemodynamics were exactly described, and factors possibly associated with early postoperative HAO were recorded and analyzed statistically. Result The incidence of early postoperative HAO in infant recipients after DCD liver transplantation was 26. 1% （6/23）. HAO initially appeared as no detection of flow？ signals in intrahepatic arterial branches in most cases, which further progressed to the occlusion of main hepatic artery. And all cases produced compensatory collateral blood flows on 14. 7 ± 2. 9 days after HAO. Grouped by hepatic artery occlusion, recipients in HAO group showed significantly higher incidence of graft-size mismatch than those in non-HAO group, and the incidence was 83.3%（5/6） ,23. 5%（4/17）, respectively（P = 0. 018）. Grouped by the graft size, the portal vein flow （PVF） showed statistically significant differences among three groups, they were 316. 91 ± 114. 96 ml/min, 158. 20 ± 66. 10 ml/min, and 110. 09 ± 33.46 ml/min in the small-sized graft group, the size-matched graft group and the large-sized graft group, respectively（P〈0. 01）. Conclusion The incidence of early postoperative HA0 was significantly higher in the size-mismatched infant recipients after DCD liver transplantation, compared with the size-matched recipients. The ability of the hepatic artery to produce compensatory flow changes in response to changes in portal venous flow, termed as hepatic arterial buffer response （HABR）, might explain the potential mechanism of HAO in the smallsized graft recipients. However, the mechanism of HAO in the large-sized graft recipients is still unclear.