大鼠DCD供肝原位肝移植术后早期死亡的原因分析

Analysis of early death causes following orthotopic liver transplantation using donation after cardiac death in rat

目的建立稳定的大鼠心脏死亡器官捐献(donation after cardiac death,DCD)供肝原位肝移植模型,分析移植后24 h内大鼠死亡原因并探索相应的改进措施。方法所有供肝获取前经历供体心脏停跳10 min,采用改良Kamada的"二袖套"吻合法完成大鼠DCD供肝原位肝移植手术,记录各个手术阶段所用时间及术后大鼠的死亡情况。结果在40 d内完成大鼠DCD供肝原位肝移植手术100例,供体手术时间为(20±5)min,受体手术时间为(55±5)min,无肝期为(20±3)min。移植术后受体一般情况可。术中死亡9例,其中术中大出血4例、麻醉意外1例、无肝期过长1例、套管置入失败1例、空气栓塞2例;术后12 h内死亡22例,其中术后肠道坏死6例、术后吻合口渗血6例、术后肺水肿3例、术中失血量过多4例、术后血管栓塞2例、不明原因死亡1例;12~24 h死亡19例,其中术后肠道坏死9例、术后吻合口渗血3例、术后肺水肿2例、术中失血量过多1例、术后血管栓塞1例、不明原因死亡3例。结论导致大鼠DCD供肝原位肝移植术后早期死亡的原因很多,其中术后肠道坏死、术中及术后出血、术后肺水肿及术后血管栓塞是主要的致死因素。针对术后死亡原因采取相应的预防及改进措施能大大提高大鼠术后存活率,从而建立稳定的大鼠DCD供肝原位肝移植模型。

Objective To establish a stable model of orthotopic liver transplantation （OLT） using donation after cardiac death （DCD） in rat, and to analyze death causes within 24 h after OLT, then explore appropriate treatment strategies for it. Methods The heart arrested 10 min before liver graft harvesting. The rat OLT model using DCD was performed by Kamada two-cuff technique. The operative time and death were recorded. Results One hundred OLT models using DCD were performed successfully within 40 d, the donor operative time was （20＋5） min, the recepient operative time was （55_＋5） min, the anhepatic phase was （20_＋3） rain. Nine rats were died during the operation, including 4 cases of massive haemorrhage, 1 case of anesthesia accident, 1 case of longer anhepatic phase, 1 case of sleeve implant failure, and 2 cases of aeroembolism. Twenty-two rats died within 12 h after the operation, including 6 cases of intestinal necrosis, 6 cases of anastomotic bleeding, 3 cases of pulmonary edema, 4 cases of intraoperative massive haemorrhage, 2 cases of vascular embolism, and 1 case of unexplained death. Nineteen rats died 12-24 h after the operation, including 9 cases of intestinal necrosis, 3 cases of anastomotic bleeding, 2 cases of pulmonary edema, 1 case of intraoperative massive haemorrhage, 1 case of vascular embolism, and 3 cases of unexplained death. Conclusions There are many reasons resulting in early death of rat OLT using DCD, postoperative intestinal necrosis, intraoperative and postoperative bleeding, and postoperative pulmonary edema are main causes. For these reasons,prevention and improvement measures are helpful to establish a stable model and improve a successful rate of rat OLT using DCD.