公民逝世后器官捐献供肝移植术后远期胆道并发症及生存分析

Analysis of long term biliary complications and survival of liver transplantation from organ donation after citizen＇s death

目的 评估公民逝世后器官捐献（DCD）肝移植的临床效果、术后胆道并发症发生率及存活情况.方法 回顾性分析2013年10月到2015年6月实施的169例DCD供肝移植的临床资料,移植物和受者的存活情况,以及术后胆道并发症发生情况.结果 术后总体胆道并发症发生率为8.28％（14/169）.缺血性胆道病6例,发生率为3.55％（6/169）.其中脑死亡器官捐献37例,胆道并发症发生率为8.11％（3/37）,缺血性胆道病1例,发生率为2.70％;心脏死亡器官捐献132例,胆道并发症发生率8.33％（11/132）,缺血性胆道病5例,发生率为3.79％.脑死亡与心脏死亡器官捐献供肝移植受者之间胆道并发症发生率的差异均无统计学意义（P＞0.05）.脑死亡器官捐献供肝移植受者术后1、2和3年存活率分别为94.5％、89.2％和83.7％,移植物存活率分别为94.5％、86.5％和81.1％;心脏死亡器官捐献供肝移植受者术后1、2和3年存活率分别为93.9％、88.6％和83.3％,移植物存活率分别为91.7％、86.4％和80.3％.二者间受者和移植物存活率的差异均无统计学意义（P＞0.05）.心脏死亡器官捐献供肝热缺血时间平均为13.59min.冷缺血时间平均为3.32 h.结论 DCD供者供肝移植效果良好.心脏死亡器官捐献供者供肝移植术后总体胆道并发症发生率及缺血性胆道病发生率与脑死亡器官捐献供者供肝移植接近.

Objective To evaluate the clinical effect,the incidence of postoperative biliary complications and the survival of liver transplantation from Chinese donation after citizen＇s death （DCD）.Methods The clinical characteristics of donors and recipients,survival of allografts and recipients,and postoperative biliary complications of 169 cases of DCD liver transplantation from October 2013 to June 2015 were analyzed retrospectively.Results The overall biliary complication rate was 8.28% （14/169）.There were 6 cases of ischemic cholangiopathy [3.55% （6/169）].In 37 cases receiving donation after brain death liver transplantation,the incidence of biliary complications was 8.11% （3/37）,and ischemic biliary disease occurred in 1 case with the incidence being was 2.70%.In 132 cases of donation after cardiac death liver transplantation,biliary complication rate was 8.33 % （11/132）,and there were 5 cases of ischemic biliary disease with the incidence being 3.79 %.There was no significant difference in the incidence of bile duct complications of the recipients between brain death and cardiac death organ donation （P〉 0.05）.The 1-,2-,and 3-year survival rate of patients and grafts of donation after brain death was 94.5%,89.2% and 83.7%,and 94.5%,86.5% and 81.1%,respectively.The 1-,2-,and 3-year survival rate of patients and grafts of donation after cardiac death was 93.9%,88.6% and 83.3%,and 91.7%,86.4% and 80.3%,respectively.There was no significant difference in survival of recipients and grafts between brain death and cardiac death organ donation （P〉0.05）.The mean warm and cold ischemia time of donation after cardiac death was 13.59 min and 3.32 h respectively.Conclusion The outcome of DCD liver transplantation is satisfactory.The incidence of overall biliary complications and ischemic biliary disease of cardiac death donor liver transplantation was close to that of brain death donor liver transplantation.