公民逝世后器官捐献肝移植70例:单中心临床分析

Clinical analysis of 70 cases of liver transplantation from organ donation after citizen’s death:A Single-Center Analysis

目的单中心分析公民逝世后器官捐献肝移植临床疗效。方法回顾性分析安徽医科大学第一附属医院器官移植中心2015年2月至2020年1月完成的70例公民逝世后器官捐献肝移植的临床资料及预后。结果70例供体中符合中国人体器官捐献分类标准中国一类(C-Ⅰ)7例、中国二类(C-Ⅱ)3例、中国三类(C-Ⅲ)60例;70例肝移植均为同一手术组完成,供肝热缺血时间(21.4±4.4)min,冷缺血时间(365.6±121.9)min,手术时间(474.3±116.6)min,无肝期(61±12.5)min,术中出血量(1124±606.1)ml,术中输红细胞(7.33±5.67)Unit,术后ClavienⅢ级及以上并发症发生率38.6%(27/70),随访期间死亡12例,术后早期(<3月)死亡7例:脓毒症/多器官功能衰竭6例、移植肝原发性无功能1例;术后晚期(≥3月)死亡5例:消化道大出血1例、移植肝新发肿瘤1例、格林巴利综合征导致心肺衰竭1例、胆道并发症2例。受体术后1、3年累积生存率分别为82.5%、78.4%。结论术后严重并发症是肝移植术后死亡的独立危险因素;受体脓毒症/多器官功能衰竭是术后早期死亡的主要原因;受体胆道并发症和合并症恶化是术后晚期死亡的主要原因;术后脓毒症可能与边缘供体,供受体源性感染,术前受体MELD评分≥25分,手术时间,术中出血量具有相关性。

Objective To analyse the clinical effect of liver transplantation from organ donation after Chinese citizen’s death at single center.Methods The clinical data and prognosis of 70 liver transplantations from organ donation after citizen’s death were retrospectively analysed in the First Affiliated Hospital of Anhui Medical University from February 2015 to January 2020.Results Among the 70 donors,7 donors met ClassⅠof Chinese Standard,3 met ClassⅡand 60 met ClassⅢ,the 70 liver transplantations were performed by the same surgical team.The warm ischemic time of donor liver was(21.4±4.4)min,the cold ischemic time was(365.6±121.9)min,the operating time was(474.3±116.6)min,the anhepatic phase was(61±12.5)min,intraoperative blood loss was(1124±606.1)ml,intraoperative red cell transfusion was(7.33±5.67)Unit,the rate of postoperative complications≥gradeⅢwas 38.6%(27/70),12 recipients died during the follow-up period,early postoperative(<3 months)death was 7 cases:6 cases of sepsis/multiple organ failure,1 case of primary nonfunction;late postoperative(≥3 months)death was 5 cases:1 case of massive gastrointestinal bleeding,1 case of denovo malignancy in transplanted liver,1 case of cardiac and respiratory failure caused by Guillain-Barre syndrome,2 cases of biliary complications.The 1-and 3-year cumulative survival rates in all recipients were 82.5%and 78.4%,respectively.Conclusion Major postoperative complications are independent risk factors for death after liver transplantation;sepsis/multiple organ failure are the main reasons of early postoperative death;biliary complications of recipient and comorbidity exacerbation are the main reasons of late postoperative death;postoperative sepsis may be related to marginal liver,donor-derived and recipient-derived infection,recipient’s MELD score≥25,operating time and intraoperative blood loss.