肝移植物再利用在肝移植术中的文献分析报告

Literature Analysis Report of the Reuse of Liver Graft in Liver Transplantation

目的:探讨移植器官在肝移植术中再利用的现状及前景。方法:检索中国知网、维普、万方、PubMed及Science Direct数据库相关文献。中文检索词为“移植器官/肝移植物 + 再利用/重复利用 + 肝移植”;英文检索词为“reuse”and“graft or liver graft”and“liver transplantation”。收录时间截至2020年6月15日。分析符合研究纳入标准的相关文献报告,统计肝移植物的供体、第一和第二接受者的临床资料。结果:经筛选,目前国际上已有19篇共计27例次重复使用肝移植物的个案报道。肝移植物的供体的年龄范围为8~69岁,其脑死亡原因主要为脑外伤(41%, 11/27)和脑血管意外(26%, 7/27),另有胰岛素中毒1例,丙戊酸中毒1例,脑脓肿1例以及活体捐赠1例,余5例原因不详。第一接受者的年龄范围为4~65岁,其原发病分别为肝硬化失代偿期占48% (13/27),急性肝衰竭占37% (10/27),肝移植术后慢性排斥反应7% (2/27),原发性硬化性胆管炎和布加综合征致肝衰竭各4% (1/27);而当这些第一接受者在肝移植后出现不可逆的神经系统病变导致脑死亡时,随之就成为了第二接受者的供体。第一接受者最常见的脑死亡原因是移植后发生脑血管意外(56%, 15/27),其次为脑水肿(30%, 8/27),此外,还包括脑缺氧、脑疝和头枪击伤各1例,余1例原因不详。再次移植距初次移植的中位间隔时间为5天(1天~13年)。再次移植的中位冷缺血时间和中位热缺血时间分别为3.9 h (0.4 h~12.4 h)和0.9 h (0.6 h~1.5 h)。第二接受者的年龄范围是29~62岁;肝硬化合并肝细胞癌(33%, 9/27)和肝硬化失代偿期(26%, 7/27)在肝移植物的再利用指征中,分列第一位和第二位。总体来看,肝移植物再利用术后1年,3年及5年生存率分别为92.4%,80.5%和64.4%;中位随访时间为16个月(1.3~125个月)。结论:据现有文献报道分析,移植物再利用在肝移植领域应用的效果尚可,但仍需更大样本数据的支持。

Objective: To investigate the current status and prospects of the reuse of grafts in liver transplantation. Methods: Relevant literature review was performed from Wanfang data, China National Knowledge Infrastructure (CNKI), Chongqing VIP, PubMed and Science Direct. The deadline for retrieval time was until June 15, 2020. the Chinese search terms were “graft” or “liver graft”;“reuse”;“liver transplantation”;the English search terms were “reuse” and “graft” or “liver graft” and “liver transplantation”;literature reports related to the reuse of liver grafts meeting the study criteria were analyzed, and the clinical data of donors for liver grafts, first and second recipients were counted. Results: After literature screening, 19 articles were eventually selected including 27 cases of the reuse of liver grafts in liver transplantation. The age range of donors for liver grafts was 8~69 years old;the main causes of their brain death are brain trauma (41%, 11/27) and cerebrovascular accidents (26%, 7/27). The age range of the first recipients ranged from 4 to 65 years, with 48% (13/27) of primary cirrhosis, 37% (10/27) of acute liver failure, 7% (2/27) of chronic rejection after liver transplantation, 4% (1/27) of primary sclerosing cholangitis and 4% (1/27) of Budd-Chiari syndrome. These first recipients became the donors of second recipients when they had developed irreversible neurological changes leading to brain death after liver transplantation. The most common cause of brain death in the first recipient was cerebrovascular accident after transplantation (56%, 15/27), followed by cerebral edema (30%, 8/27), in addition, there was also cerebral hypoxia, cerebral hernia and gunshot wound in 1 case each, and the cause of the remaining 1 case was unknown. The median interval between retransplantation and primary transplantation was 5 days (1~13 years). The median cold ischemia time and the median hot ischemia time were 3.9 h (0.4 h~12.4 h) and 0.9 h (0.6 h~1.5 h), respectively. The age range for the second recipients was 29~62 years;The main indications for reusing liver grafts were cirrhosis with hepatocellular carcinoma (33%, 9/27) and decompensated cirrhosis (26%, 7/27). Overall, the 1-year, 3-year, and 5-year survival rates after liver graft reuse were 92.4%, 80.5%, and 64.4%, respectively. The median follow-up was 16 months (1.3~125 months).Conclusions: According to the analysis of the existing literature, the application effect of the reuse of grafts in the field of liver transplantation is fair, but it still needs to be supported by larger sample data.