三种类型的器官捐献供肝移植临床疗效及并发症的比较

Comparison of three types of china donation after citizen＇ s death in clinical efficacy and complications after liver transplantation： a report of 422 cases

目的比较3种不同类型器官捐献（即中国一类、中国二类、中国三类）供肝移植的临床疗效、并发症和存活率。方法收集2010年6至2016年6月422例肝移植受者的临床资料，其中接受中国一类、中国二类和中国三类肝移植分别为124例、81例和217例，并分别设为中国一类肝移植组，中国二类肝移植组和中国三类肝移植组，手术方法以背驼式肝移植为主。观察指标：（1）受者术后肝功能；（2）术后并发症；（3）受者存活率。结果（1）3组受者术后疗效根据丙氨酸转氨酶（ALT）和胆红素总量（TBil）进行评估。与中国一类肝移植组和中国三类肝移植组比，中国二类肝移植组ALT较高（P〈0．05），疗效较差。（2）3组术后并发症比较：在中国一类肝移植组中移植物原发无功能（PNF）发病率为3．23％，中国二类肝移植组PNF发病率为9．88％，中国三类肝移植组PNF发病率为2．30％（P〈0．05）；中国一类肝移植组中急性排斥反应发病率为9．68％，中国二类肝移植组急性排斥反应发病率为38．27％，中国三类肝移植组急性排斥反应发病率为24．89％（P〈0．001）；中国一类肝移植组全身炎症反应综合征发病率为5．65％，中国二类肝移植组全身炎症反应综合征发病率为39．50％，中国三类肝移植组全身炎症反应综合征发病率为10．14％（P〈0．001）；其他并发症的发病率3组比较，差异无统计学意义。（3）中国二类肝移植组术后3个月内死芒14例，死亡率为17．28％，存活率为82．72％；中国一类肝移植组1、3、5年存活率分别为76．55％、74．18％、69．14％；3组中受者1、3、5年存活率分别为88．（）2％、85．72％、81．11％。结论自2015年6月起，与中国二类比较，中国一类器官捐献的数量同比增长较快；同时，与中国二类比较，接受中国一类器官捐献的受者近期及远期临床效果较好；如何对3种不同类型器官捐献的供者器官进行修复和质量优化是保障中国器官移植事业健康发展的研究热点，需要研究者不断探究。

Objective To compare three different types of donor livers （C-Ⅰ, C-Ⅱ, C-Ⅲ） in clinical efficacy, complications and survival rate of liver transplantatiorL Methods Using the retrospective descriptive study method, the clinical data of 422 patients undergoing liver transplantation, including 124 cases of C-Ⅰ, 8l cases of C-Ⅱ and Ⅲ cases of CIII in recent 6 years （from June 2010 to June 2016） were analyzed. The same surgical method was performed with piggy- hack liver transplantation. Observation indicators contained （1） recipient postoperative liver function; （2） the postoperative complications; （3） the recipient survival rate. SPSS 19. 0 statistical software was used for analysis. Results （1） The curative effect was evaluated by the changes of ALT and TBIL among three groups of recipients postoperatively. As compared with C-I transplantation group and C-Ⅲ transplantation group, the level of ALT in C-II transplantation group was significantly increased （P d0. 05）, the clinical efficacy was poorer. （2） The incidence of PNF was 3. 23% in C-I group, 9. 88% in C-Ⅱ group and 9. 88% in C-Ⅲ group （P〈0. 05）. The incidence of acute rejection was respectively 9. 68% in C-I group, 38. 27% in C-Ⅱ group and 38. 27% in C-III group （P〈0. 001）. The incidence of SIRS was respectively 5. 65% in C-I group, 39. 50% in C-II group and 39. 50% in C-III group （P〈0. 001）. There were significant differences in the incidence of other complications among the three groups. （3） There were 14 deaths within 3 months, accounting for 17. 28%, and the survival rate was 82. 72% in C-II group, the 1-, 3-, and 5-year survival rate was 76. 55%, 74. 18% and 76. 55% respectively in C-I group, and that was 88. 02%, 85.72% and 81.11% respectively in C-Ⅲ group. Conclusion Since June 2015, C-I donors grow up more quickly on year-on-year basis than C-II. Simultaneously, the sort-term and long-term clinical efficacy is better in C-I transplantation group than in C-II transplantation group. How to repair the three types of Chinese standard donor organs and optimize the quality is still a hot point to ensure the healthy development of organ transplantation in China, which needs further investllxntion