体外膜肺氧合在心脏死亡供体肝移植中的应用进展

Research progress of extracorporeal membrane oxygenation in liver transplantation using donation after cardiac death

供肝严重短缺是全世界肝脏移植发展面临的难题。心脏死亡器官捐献(DCD)是目前拓展供肝来源的重要途径。DCD相对较长的热缺血时间(WIT)是导致其术后原发性移植物无功能以及缺血性胆道疾病等并发症发生率较高的根本原因。因此,如何避免或减轻DCD供肝热缺血损伤进而保护移植受体的安全是当前DCD研究的一个热点。体外膜肺氧合(ECMO)为DCD提供临时呼吸循环支持,保障供体器官灌注,可以明显减少DCD供肝WIT,减轻热缺血对供肝的损伤,而且还可为评估潜在DCD赢得时间,便于医院间安全转运,提高了潜在DCD捐献成功率和移植成功率。尽管ECMO在DCD供肝肝移植的应用中还存在一些诸如伦理学、技术学等方面的争议,相信随着社会和技术的不断发展,ECMO必将成为促进DCD供肝肝移植走向成熟的一个重要措施。

There is an ongoing shortfall of liver organ donor in the development of liver transplantation in the world wide. Donation after cardiac death（DCD） is an important way to increase the number of liver donors at the present stage.The use of DCD livers was associated with a significantly higher risk of primary nonfunction and ischemic biliary complications because of prolonged warm ischemia time（WIT）. It is a paramount research dilemma to devise how to avert or lessen the warm ischemia injury of DCD livers. Extracorporeal membrane oxygenation（ECMO） can minimize the WIT and injuries induced by warm ischemia through providing respiratory and circulatory support and increasing the perfusion of the organ. Moreover, ECMO facilitates safe transfer of potential DCD donors between hospitals and assessment of the potential DCD graft function, thus enhance the potential DCD donation success ratio and success rate of transplantation. Although, there are some ongoing controversies such as the ethical and technical issues about the use of ECMO in liver transplantation using DCD. It is believed that the application of ECMO will be an important measure to promote the development of liver transplantation using DCD with the continuous development of society and technology.