儿童器官捐献婴儿肝移植术后早期肝动脉侧支循环的临床研究

Collateral formation after hepatic artery occlusion in infant recipients early after donation-after-cardiac-death liver transplantation

目的 总结儿童器官捐献婴儿肝移植术后早期肝动脉侧支循环形成的临床特点,初步探讨发生该现象的潜在因素.方法 回顾性分析我院2013年12月至2015年12月的儿童器官捐献婴儿肝移植共49例,15例术后早期发生移植肝动脉闭塞,其中2例术后1周内死亡的受者被剔除出本研究,搜集其余13例受者的所有临床资料,分析该组病例术后的临床过程及预后.结果 儿童器官捐献婴儿肝移植术后早期肝内动脉分支闭塞9例,肝动脉主干闭塞4例,闭塞发生时间为术后（4.7±1.8）d.肝动脉分支闭塞组的9例患儿于闭塞发生后（9.7±5.3）d肝内动脉血流恢复;肝动脉主干闭塞组的4例患儿于闭塞发生后的（9.8±3.2）d出现肝内动脉侧支循环,于闭塞发生后的（20.0±5.0）d出现肝门部的动脉侧支循环.随访结果,有4例患儿术后发生胆道并发症,每组各2例,肝动脉主干闭塞组的1例行二次肝移植,余3例接受经皮肝穿刺胆道引流及球囊扩张治疗,移植肝功能基本正常.结论 肝动脉分支闭塞是儿童器官捐献婴儿肝移植术后早期肝动脉闭塞的主要类型.发生肝动脉主干闭塞的患儿均能在短期内建立代偿性侧支循环,对于远期可能发生的胆道并发症注意密切监测,及时治疗,长期临床预后有待进一步观察.

Objective To summarize the clinical characteristics of collateral circulation after hepatic artery occlusion （HAO） during early postoperative stage in infant recipients undergoing donation-after-cardiac-death （DCD） liver transplantation and further discuss the potential factors associated with collateral formation.Methods A total of 49 infant recipients of DCD liver transplantation from December 2013 to December 20t5 were recruited.Among them,15 cases had HAO at early postoperative stage.Two cases dead within the first postoperative week were excluded.The clinical data of the other 13 cases were retrospectively collected by reviewing medical charts.Clinical features of collaterals after HAO were reviewed and their outcomes analyzed.Results Among 13 infant recipients,9 patients had hepatic arterial branch occlusion （group HABO） while the other 4 patients main hepatic artery occlusion （group MHAO）.The mean time of HAO detection was （4.7 ± 1.8） days post-transplantation.Intrahepatic arterial branch flows were restored in all HABO patients at （9.7 ± 5.3） days post-HABO.Additionally,for all of four MHAO patients,intrahepatic artery collaterals developed at （9.8 ± 3.2） days post-MHAO and extrahepatic artery collaterals at （20.0 ± 5.0） days post-MHAO.Two patients in each group had ischemia biliary complications.One patient of graft nonfunction in MHAO group received retransplantation while the remainder had percutaneous transhepatic cholangial drainage and balloon dilation.And nearly normal liver function maintained at the last follow-up.Conclusions Arterial branch occlusion is the major presentation of early postoperative HAO in infant recipients undergoing DCD liver transplantation.Rapid collateral formation appears in all patients with MHAO.However,the incidence of biliary complications remains high and close monitoring is required.And long-term outcomes need further evaluations.