心脏死亡器官捐献供肝肝移植182例单中心经验总结

Experience summary of 182 patients undergoing liver transplantation from donation after cardiac death in a single center

目的总结心脏死亡器官捐献(DCD)供肝肝移植的临床效果。方法回顾性分析182例DCD供肝肝移植供、受者的临床资料。根据原发病不同将182例受者分为良性组(135例)及肝细胞癌(肝癌)组(47例)。比较两组受者围手术期情况及1年、3年存活率;总结受者的临床预后及术后并发症发生情况,包括移植物早期功能障碍(EAD)、血管并发症、急性肾损伤(AKI)、肺部感染、急性排斥反应、巨细胞病毒(CMV)感染及胆道并发症。结果两组受者的无肝期、手术时间、重症监护室(ICU)停留时间比较,差异均无统计学意义(均为P>0.05)。182例受者的1年人、移植物存活率均为93.1%,3年人、移植物存活率均为84.9%。良性组受者的1年和3年存活率分别为92.5%和88.1%,肝癌组受者的1年存活率及无病存活率分别为95%和91%,3年存活率为78%。两组受者的总体存活率比较,差异无统计学意义(P=0.879)。术后并发症包括胆道并发症26例,血管并发症14例,AKI 34例,肺部感染22例,急性排斥反应11例,EAD11例,CMV感染10例,其中放置T管者的术后胆道并发症的发生率比未放置T管者明显降低(8%比19%,P<0.05)。结论 DCD供肝肝移植是治疗各类终末期肝病及肝癌的良好手段,术后短期疗效较好。

Objective To summarize the clinical efficacy of liver transplantation from donation after cardiac death （DCD）. Methods Clinical data of both the donors and recipients （n=182） undergoing liver transplantation from DCD were retrospectively analyzed. According to the type of primary diseases, 182 recipients were divided into the benign group （n=135） and hepatocellular carcinoma （liver cancer） group （n=47）. Perioperative conditions, 1- and 3-year survival rate of the recipients were statistically compared between two groups. Clinical prognosis and the incidence of postoperative complications of the recipients were summarized. Postoperative complications mainly included early allograft dysfunction （EAD）, vascular complications, acute kidney injury （AKI）, pulmonary infection, acute rejection, cytomegalovirus （CMV） infection and billiary tract complication. Results No statistical significance was identified in the anhepatic phase, operation time and length of intensive care unit （ICU） stay between two groups （all P〉0.05）. The 1-year survival rates of the 182 recipients and grafts were 9311%, and 84.9% for the 3-year survival rates. In the benign group, the 1- and 3-year survival rates of the recipients were 92.5% and 88.1%. In the liver cancer group, the 1-year survival rate of the recipients was 95%, 91% for the disease-free survival rate, and 78% for the 3-year survival rate, respectively. No statistical significance was noted in the overall survival rate of the recipients between two groups （P=-0.879）. In terms of postoperative complications, billiary tract complications occurred in 26 patients, vascular complications in 14, AKI in 34, pulmonary infection in 22, acute rejection in 11, EAD in 1 l and CMV infection in 10. The incidence of postoperative billiary tract complications in patients with T-tube insertion was significantly lower than that in their counterparts without T-tube insertion （8% vs. 19%, P〈0.05）. Conclusions Liver transplantation from DCD is an efficacious treatment for end-stage liver diseases and liver cancer, which yields relatively high short-term clinical efficacy.