儿童DCD供肝成人肝移植术后早期血流动力学变化的临床观察

Clinical observation for hemodynamic changes of children DCD donor liver in adult recipients during early stage

目的探讨儿童公民逝世后器官捐献(DCD)供肝成人肝移植术后早期血流动力学的变化。方法回顾性分析2014年7月-2017年6月山西省人民医院肝胆胰外科完成的3例儿童DCD供肝成人肝移植术的临床资料。手术术式为经典原位肝移植、术中结扎脾动脉及胆道放置T管。术后检测丙氨酸转氨酶(ALT)、胆汁引流量及总胆红素值(TBi L)。彩超监测门静脉与肝动脉血流量。术后回访患者恢复情况。结果共纳入3例手术,供体均为男性,平均年龄9岁,受体均为女性,为丙肝肝硬化或乙肝肝硬化,供肝体积与受体标准肝体积比(GV/SLV)分别为45%、60%、62%,供肝重量与受体体重比(GRWR)分别为1%、1.4%、1.4%。术后肝功能恢复良好,约1周即恢复正常,术后7天与1天相比,TBi L、ALT、门静脉流速、肝动脉阻力指数降低,胆汁引流量增加。术后随访6个月,恢复良好,生存率为100%。结论儿童DCD供肝应用于条件相匹配的成人受体是安全有效的,早期血流动力学无显著变化。

Objective To investigate the clinical result of an adult recipient who received donation after citizen＇s death（DCD）donor from a child and to analyze the hemodynamic changes after this transplantation. Methods The clinical data of three children DCD donors have been transplanted to adult recipients successfully between July 2014 to June 2017 in hepatopancreatobiliary surgery department,Shanxi Provincial People＇s Hospital, were analyzed retrospectively. All the patients accepted orthotopic liver transplantations and intraoperative ligation of spleen artery was conducted and T tube was placed into bile duct. Alanine aminotransferase（ALT）, bile flow and total bilirubin（TBi L） were recorded. The blood flows of portal vein and hepatic artery were monitored by color Doppler ultrasound. After one year of follow-up,the recipient recovered smoothly. Results All the three donors were male and 9 years old on average. All the recipients were female, they suffered from HBV or HCV related liver cirrhosis. The ratios of graft volumes to recipient standard liver volumes（GV/SLV）were 45%, 60% and 62%, respectively,The Ratios of donor liver weights to recipient body weights（GRWR）were 1%,1.4% and 1.4%, respectively. Liver functions recovered smoothly. The levels of ALT returned to normal range 1 week after operation. Compared to 1 day after operation, TBi L, ALT, the portal vein flow and hepatic artery resistance index were decreased in the 7 day after operation, and bile drainage was increased. Postoperative follow-up was conducted for six months, the patient recovered well, survival rate was 100%. Conclusion The DCD children liver can be successfully implanted into relatively well-matched adult recipient. This operation is safe and effective, early hemodynamic has no significant change.