81岁供者供肝移植成功一例并文献复习

A successful liver transplantation from an 81-year-old donor and literature review

目的探讨肝移植中供、受者选择、获取和匹配的优化,能够让老年供肝的使用达到最佳的效果。方法对中山大学附属第一医院1例81岁老年供者供肝移植手术进行报道,供者为81岁女性,为脑死亡供者,受者为21岁男性,因慢性乙型病毒性肝炎合并肝细胞癌行肝移植手术。结合文献讨论与年龄相关的边缘供肝应用于临床肝移植时的初步经验。结果受者术后恢复顺利,术后第1天天冬氨酸转氨酶(AST)为1131 U/L、丙氨酸转氨酶(ALT)为846 U/L,术后均进行性下降,2周后均降至正常,术后第1天总胆红素(TBIL)56.4μmol/L,第3天下降至22.1μmol/L,但术后第5天开始升高,最高66.0μmol/L,术后2个月左右降至正常。术后未出现并发症,术后随访AST、ALT、TBIL等指标均正常,甲胎蛋白进行性下降。结论对高龄供者进行仔细的评估,选择一些低风险的受者,老年供肝可以安全应用于临床。

Objective To explore how to optimize selection,acquisition,and matching for the use of an aged donor liver.Methods A case of 81-year-old senior donor liver transplantation performed at our institution is reported,the donor was an 81-year-old female who was brain-dead and the recipient was a 21-year-old male who underwent liver transplantation because of chronic hepatitis B complicated with hepatocellular carcinoma.Combined with the literature,the preliminary experience of age-related marginal donor liver in clinical liver transplantation was discussed.Results The recipient recovered smoothly.Aspartate aminotransferase(AST)and glutamate-pyruvate transaminase(ALT)were 1131 U/L and 846 U/L on the first postoperative day,and decreased gradually to normal until 2 weeks later.Total bilirubin(TBIL)56.4umol/L on the first day and decreased to 22.1umol/L on the third day after operation,however,it began to rise on postoperative day 5 to a maximum of 66.0 umol/L,which decreased to normal about 2 months after surgery.During the follow-up,AST,ALT,TBIL and other indexes were normal,and AFP decreased progressively.Conclusions Using of elderly liver donors may achieve satisfactory results,asifthe elderly donors been evaluatedcarefullyandthe low-risk recipients been selected.