体外膜肺氧合辅助心脏死亡器官捐献肝移植九例并文献复习

Extracorporeal membrane oxygenation-assisted liver transplantation of organ donation after cardiac death:report of 9 cases and literature review

目的探讨体外膜肺氧合(ECMO)辅助心脏死亡器官捐献(DCD)肝移植疗效。方法回顾性分析2015年5月至2016年9月于中山大学附属第三医院诊治的36例DCD供者及26例肝移植受者临床资料。供者男29例,女7例;年龄11~65岁,中位年龄39岁;原发病:重型颅脑外伤14例,脑血管意外16例,缺血缺氧性疾病6例。根据是否接受ECMO支持,将供者分为ECMO组(9例)和非ECMO组(27例)。ECMO组9例均存在明显的血流动力学不稳定。所有受者均为初次肝移植,均签署知情同意书,符合医学伦理学规定。供者均符合《中国心脏死亡器官捐献工作指南》,按标准成功完成肝脏和肾脏捐献。两组热缺血时间比较采用t检验,肝肾功能比较采用秩和检验。结果ECMO组1例供者因ECMO机械故障导致肝、肾丢弃,非ECMO组2例因热缺血时间过长导致肝、肾丢弃。ECMO组供肝热缺血时间(4.8±0.4)min,明显少于非ECMO组的(24.1±8.0)min(t=-7.89,P<0.05)。ECMO组肝移植受者术后5、7 d ALT,术后7 d Scr明显低于非ECMO组(Z=-2.10,-2.14,-2.03;P<0.05)。结论ECMO支持可使血流动力学不稳定的DCD供者肝肾热缺血时间缩短,肝移植受者可获得良好的手术效果。

Objective To evaluate the clinical efficacy of extracorporeal membrane oxygenation(ECMO)-assisted liver transplantation of donation after cardiac death(DCD).Methods Clinical data of 36 donors of DCD and 26 recipients undergoing liver transplantation from May 2015 to September 2016 in the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed.Among 36 donors,29 cases were male and 7 female,aged 11-65 years with a median age of 39 years.Primary diseases:14 cases of severe craniocerebral trauma,16 cerebrovascular accidents and 6 ischemic and anoxic diseases.According to whether ECMO was employed,all donors were divided into the ECMO group(n=9)and non-ECMO group(n=27).In the ECMO group,9 cases presented with obvious hemodynamic instability.All the recipients underwent liver transplantation for the first time.The informed consents of all patients were obtained and the local ethical committee approval was received.All donors completed the liver and kidney donation successfully which were met the Guidelines for Donation after Cardiac Death in China.The warm ischemia time between two groups was statistically compared by t test.The liver and kidney functions were compared by rank sum test.Results One donor in the ECMO group was excluded due to mechanical failure of ECMO,whereas 2 donors in the non-ECMO group were excluded due to prolonged warm ischemia time.The warm ischemia time of donor liver in the ECMO group was(4.8±0.4)min,significantly shorter than(24.1±8.0)min in the non-ECMO group(t=-7.89,P<0.05).The ALT levels at postoperative 5,7 d,and Scr level at postoperative 7 d in the ECMO group were remarkably lower compared with those in the non-ECMO group(Z=-2.10,-2.14,-2.03;P<0.05).Conclusions ECMO support can shorten the warm ischemia time of the liver and kidney of DCD donors with unstable hemodynamics.The recipients undergoing liver transplantation may obtain good clinical efficacy.