Donor-derived infections among Chinese donation after cardiac death liver recipients

AIM To investigate blood cultures of deceased donors and report the confirmed transmission of bacterial infection from donors to liver recipients.METHODS We retrospectively studied the results of blood cultures among our donation after cardiac death(DCD) donors and calculated the donor-derived bacterial infection rates among liver recipients. Study participants underwent liver transplantation between January 1, 2010 and February 1, 2017. The study involved a total of 67 recipients of liver grafts from 67 DCD donors. We extracted the data of donors' and patients' characteristics, culture results and clinical outcomes, especially the post-transplant complications in liver recipients, from electronic medical records. We analyzed the characteristics of the donors and the corresponding liver recipients with emphasis put on donor-derived infections.RESULTS Head trauma was the most common origin of death among our 67 DCD donors(46.3%). Blood taken prior to the procurement operation was cultured for 53 of the donors, with 17 episodes of bloodstream infections developing from 13 donors. The predominant organism isolated from the blood of donors was Gram-positive bacteria(70.6%). Only three(4.5%) of 67 liver recipients developed confirmed donor-derived bacterial infections,with two isolates of multidrug-resistant Klebsiella pneumoniae and one isolate of multidrug-resistant Enterobacter aerogenes. The liver recipients with donorderived infections showed relation to higher crude mortality and graft loss rates(33.3% each) within 3 mo post transplantation, as compared to those without donor-derived infections(9.4% and 4.7%, respectively). All three liver recipients received appropriate antimicrobial therapy.CONCLUSION Liver recipients have high occurrence of donor-derived infections. The liver recipients with donor-derived multidrug-resistant Enterobacteriaceae infections can have good outcome if appropriate antimicrobial therapy is given.

Developing a donation after cardiac death risk index for adult and pediatric liver transplantation

AIM To identify objective predictive factors for donor after cardiac death(DCD) graft loss and using those factors, develop a donor recipient stratification risk predictive model that could be used to calculate a DCD risk index(DCD-RI) to help in prospective decision making on organ use.METHODS The model included objective data from a single institute DCD database(2005-2013, n = 261). Univariate survival analysis was followed by adjusted Cox-regressional hazard model. Covariates selected via univariate regression were added to the model via forward selection, significance level P = 0.3. The warm ischemic threshold was clinically set at 30 min. Points were given to each predictor in proportion to their hazard ratio. Using this model, the DCD-RI was calculated. The cohort was stratified to predict graft loss risk and respective graft survival calculated.RESULTS DCD graft survival predictors were primary indication for transplant(P = 0.066), retransplantation(P = 0.176), MELD > 25(P = 0.05), cold ischemia > 10 h(P = 0.292) and donor hepatectomy time > 60 min(P = 0.028).According to the calculated DCD-RI score three risk classes could be defined of low(DCD-RI < 1), standard(DCD-RI 2-4) and high risk(DCD-RI > 5) with a 5 years graft survival of 86%, 78% and 34%, respectively.CONCLUSION The DCD-RI score independently predicted graft loss(P < 0.001) and the DCD-RI class predicted graft survival(P < 0.001).

Liver transplantation with grafts obtained after cardiac death-current advances in mastering the challenge

The scarcity of donor livers has increased the interest in donation after cardiac death(DCD) as an additional pool to expand the availability of organs. However, the initial results of liver transplantation with DCD grafts have been suboptimal due to an increased rate of complications, as well as decreased graft survival. These challenges have led to many developments in DCD donation outcome, as well as basic and translational research. In this article we review the unique characteristics of DCD donors, nuances of DCD organ procurement, the effect of prolonged warm and cold ischemia times, and discuss major studies that compared DCD to donation after brain death liver transplantation, in terms of outcomes and complications. We also review the different methods of donor treatment that has been applied to ameliorate DCD organ outcome, and we discuss the role of machine perfusion techniques in organ reconditioning. We discuss the two major perfusionmodels, namely, hypothermic machine perfusion and normothermic machine perfusion; we compare both methods, and delineate their major differences.

Kidney donation after cardiac death

There is continuing disparity between demand for and supply of kidneys for transplantation. This review describes the current state of kidney donation after cardiac death （DCD） and provides recommendations for a way forward. The conversion rate for potential DCD donors varies from 40%-80%. Compared to con-trolled DCD, uncontrolled DCD is more labour intensive, has a lower conversion rate and a higher discard rate. The super-rapid laparotomy technique involving direct aortic cannulation is preferred over in situ perfusion in controlled DCD donation and is associated with lower kidney discard rates, shorter warm ischaemia times and higher graft survival rates. DCD kidneys showed a 5.73-fold increase in the incidence of delayed graft function （DGF） and a higher primary non function rate compared to donation after brain death kidneys, but the long term graft function is equivalent between the two. The cold ischaemia time is a controllable factor that signifcantly infuences the outcome of allografts, for example, limiting it to 〈 12 h markedly reduces DGF. DCD kidneys from donors 〈 50 function like stan-dard criteria kidneys and should be viewed as such. As the majority of DCD kidneys are from controlled dona-tion, incorporation of uncontrolled donation will expand the donor pool. Efforts to maximise the supply of kid-neys from DCD include： implementing organ recovery from emergency department setting; improving family consent rate; utilising technological developments to optimise organs either prior to recovery from donors or during storage; improving organ allocation to ensure best utility; and improving viability testing to reduce primary non function.

Effect of cardiac output-guided hemodynamic management on acute lung injury in pediatric living donor liver transplantation

BACKGROUND Acute lung injury(ALI)after liver transplantation(LT)may lead to acute respiratory distress syndrome,which is associated with adverse postoperative outcomes,such as prolonged hospital stay,high morbidity,and mortality.Therefore,it is vital to maintain hemodynamic stability and optimize fluid management.However,few studies have reported cardiac output-guided(CO-G)management in pediatric LT.AIM To investigate the effect of CO-G hemodynamic management on early postoperative ALI and hemodynamic stability during pediatric living donor LT.METHODS A total of 130 pediatric patients scheduled for elective living donor LT were enrolled as study participants and were assigned to the control group(65 cases)and CO-G group(65 cases).In the CO-G group,CO was considered the target for hemodynamic management.In the control group,hemodynamic management was based on usual perioperative care guided by central venous pressure,continuous invasive arterial pressure,urinary volume,etc.The primary outcome was early postoperative ALI.Secondary outcomes included other early postoperative pulmonary complications,readmission to the intense care unit(ICU)for pulmonary complications,ICU stay,hospital stay,and in-hospital mortality.RESULTS The incidence of early postoperative ALI was 27.7%in the CO-G group,which was significantly lower than that in the control group(44.6%)(P<0.05).During the surgery,the incidence of postreperfusion syndrome was lower in the CO-G group(P<0.05).The level of intraoperative positive fluid transfusions was lower and the rate of dobutamine use before portal vein opening was higher,while the usage and dosage of epinephrine during portal vein opening and vasoactive inotropic score after portal vein opening were lower in the CO-G group(P<0.05).Compared to the control group,serum inflammatory factors(interleukin-6 and tumor necrosis factor-α),cardiac troponin I,and N-terminal pro-brain natriuretic peptide were lower in the CO-G group after the operation(P<0.05).CONCLUSION CO-G hemodynamic management in pediatric living-donor LT decreases the incidence of early postoperative ALI due to hemodynamic stability through optimized fluid management and appropriate administration of vasopressors and inotropes.

Outcome of kidney transplantation between controlled cardiac death and brain death donors： a meta-analysis

Background Our goal was to evaluate the outcomes of kidney transplants from controlled cardiac death donors compared with brain death donors by conducting a meta-analysis of cohort studies.Methods The PubMed database and EMBASE were searched from January 1980 to July 2013 to identify studies that met pre-stated inclusion criteria.Reference lists of retrieved articles were also reviewed.Two authors independently extracted information on the designs of the studies,the characteristics of the study participants,and outcome assessments.Results Nine cohort studies involving 84 398 participants were included in this meta-analysis; 3 014 received kidneys from controlled cardiac death donors and 80 684 from brain death donors.Warm ischemia time was significantly longer for the controlled cardiac death donor group.The incidence of delayed graft function was 2.74 times （P 〈0.001） greater in the controlled cardiac death donor group.The results are in favor of the brain death donor group on short-term patient and graft survival while this difference became nonsignificant at mid-term and long term.Sensitivity analysis yielded similar results.No evidence of publication bias was observed.Conclusion This meta-analysis of retrospective cohort studies suggests that the outcome after controlled cardiac death donors is comparable with that obtained using kidneys from brain death donors.

Beneficial Effect of Moderately Increasing Hypothermic Machine Perfusion Pressure on Donor after Cardiac Death Renal Transplantation

Background:Vascular resistance and flow rate during hypotherrnic machine perfusion (HMP)of kidneys is correlated with graft function. We aimed to determine the effects of increasing HMP pressure versus maintaining the initial pressure on kidney transplantation outcomes. Methods:We retrospectively reviewed the data of 76 primary transplantation patients who received HMP-preserved kidneys from 48 donors after cardiac death between September 1,2013,and August 31,2015.HMP pressure was increased from 30 to 40mmHg (1mmHg =0.133kPa)in kidneys with poor flow and/or vascular resistance (increased pressure [IP]group;36 patients);otherwise,the initial pressure was maintained (constant pressure group;40 patients).Finally,the clinical characteristics and transplantation outcomes in both groups were assessed. Results:Delayed graft function (DGF)incidence,1-year allograft,patient survival,kidney function recovery time,and serum creatinine level on day 30 were similar in both groups,with improved flow and resistance in the IP group.Among patients with DGF,kidney function recovery time and DGF duration were ameliorated in the IP group.Multivariate logistic regression analysis revealed that donor hypertension (odds ratio [OR]:1.43,95%confidence interval [CI]:1.02-2.06,P =0.035),donor terminal serum creatinine (OR:1.27,95%C7:1.06-1.62,P =0.023),warm ischemic time (OR:3.45,95%CI:1.97-6.37,P =0.002),and terminal resistance (OR:3.12,95%CI:1.76-6.09,P =0.012)were independent predictors of DGF.Cox proportional hazards analysis showed that terminal resistance (hazard ratio:2.06,95%C1:1.32-5.16,P =0.032)significantly affected graft survival. Conclusion:Increased HMP pressure improves graft perfusion but does not affect DGF incidence or 1-year graft survival.

BAL联合M-ROSE在潜在供肺维护中的作用

目的探讨BAL联合M-ROSE在潜在供肺维护中的作用。方法选取昆明医科大学附属甘美医院重症医学科2020年09月至2022年12月收治的符合纳入标准的脑死亡患者行BAL,留取灌洗液行M-ROSE比较病原菌检出率及初步诊断时间。根据M-ROSE结果阳性的患者采用经验性抗感染治疗,评估抗感染治疗48 h前后的氧合指数、胸部X线评分、感染指标(WBC、CRP、PCT)变化。结果(1)病原菌检出率比较:MROSE对细菌感染初步诊断结果与检验科报告的结果表现出高度一致性(Kappa=0.921,P<0.001);(2)诊断时效性比较:M-ROSE初步诊断时间与常规涂片报告时间、微生物培养时间比较,差异有统计学意义(P<0.001);(3)抗感染治疗48 h的疗效比较:抗感染治疗前后氧合指数,白细胞,超敏C反应蛋白差异无统计学意义(P>0.05);抗感染治疗前后胸部X线,降钙素原差异有统计学意义(P<0.05)。结论BAL联合M-ROSE在潜在供肺肺部感染中的诊断时效性高,可以为供肺维护早期抗感染治疗提供初步的依据。

中国遗体器官捐献供肾体外低温机械灌注保存指南

为促进遗体器官捐献供肾体外低温机械灌注保存技术的规范应用,中华医学会器官移植学分会组织制定了《中国遗体器官捐献供肾体外低温机械灌注保存指南》。该指南整合了肾脏移植学和遗体器官捐献学领域的专家共识,依据现有的临床指南、系统评价、病例研究、专家共识等资料,并结合近年国内外遗体器官捐献供肾体外低温机械灌注保存技术的临床问题。在多次专家研讨和达成一致意见后,完成了该指南的撰写。该指南共包含11个临床问题,14条推荐意见,并按照2009版牛津大学循证医学中心的证据分级与推荐强度标准,对每个临床问题的推荐意见强度与证据级别进行了分级。该指南旨在为临床实践提供指导,提高我国遗体器官捐献供肾保存水平,减少器官弃用率,缓解器官短缺问题。

边缘供肝面临的机遇与挑战

随着手术技术和术后免疫抑制治疗的不断突破与成熟,肝移植受者和移植物存活率显著提高,供肝短缺已成为限制肝移植临床发展的主要阻碍,如何扩大供肝来源也成为了当前迫切需要解决的问题。高龄供肝、脂肪变性供肝、病毒性肝炎供肝、心脏死亡器官捐献供肝等常见边缘供肝在临床肝移植中的使用已经取得了一定的突破性进展,但边缘供肝的使用仍存在较多限制。因此,本文对边缘供肝的定义,几种常见边缘供肝的应用及研究进展进行综述,探讨目前边缘供肝面临的机遇与挑战,旨在为临床肝移植供者池的扩大提供参考,造福更多终末期肝病患者。

Overview of Kidney Transplantation: A Single Centre Report from China

Introduction: Worldwide, End Stage Renal Disease (ESRD) is one of the leading disease with prolong morbidity. Kidney transplantation offers the best solution for the problem. The shortage of donor kidney is even bigger problem due to transplantation being one of the routine procedures. The use of deceased donor definitely increases the pool of donor with excellent immediate and long-term follow-up proven results. Aim: The aim is to analyze and summarize the outcome of Kidney transplantation. Methods & Materials: A total of 78 cases of Kidney Transplantation were selected for the study and categorized as: Group I—41 (living Donor), Group II—23 (DCD) & Group III—15 (DBD). Perspective study was done with clean data recorded & maintained pre-operatively, post-operatively and follow-up from Jan 2011 to Dec 2015 in our hospital. Post-operative graft status, complications and at least 1-year follow-up were area of main focus. Results: All patients underwent successful kidney transplantation. In Group I, the number of living donor kidney transplantation is 41 whereas in Group II (DCD) & III (DBD), the number of deceased donor transplantation is 23 and 15 respectively. The Normal functioning of graft (NGF) was 38 (87.8%), 16 (69.6%) & 11 (73.3%) in Group I, II & III respectively along with Poor Graft function (PGF) in Group I—4 (9.7%), II—5 (21.7%) & III—2 (13.3%) managed by continuing dialysis. Delayed graft function (DGF) was noted I-1 (2.4%), II-2 (8.6%) & III-1 (6.6%) in respective group, which returned to normal function post intervention. Therefore, 1st year graft survival was >93% [(Group I (97.6%), Group II (95.6%) & Group III (93.3%) respectively]. Manageable surgical complication were found in Group I—8 (19.5%), Group II—5 (21.7%) & Group III—2 (13.3%) like hematoma, hydronephrosis, leakage except one emboli related nephrectomy of transplanted kidney & one pneumonia led death in Group II. The overall survival was greater than 90% [(Group I (97.6%), Group II (91.3%) & Group III (93.3%) respectively] in all three groups after at least 1-year follow-up study, which was an excellent prognosis. Conclusion: Kidney Transplantation is safe, effective and the best method of treatment for ESRD. Significant improvement in quality of life is the hallmark merit over dialysis. Paired donation program should be encouraged in order to overcome shortage of kidney, which increases living donor pool. Outcome in living donor Kidney transplantation is always better than deceased donor transplantation. The prognosis of deceased donor transplantation (1 year Graft survival > 93% & 1 year patient survival > 90%) is also satisfactory with promising results. Therefore all the results were under acceptable standard limit. Thus, kidney transplantation (live or deceased donor) should be encouraged as primary modalities in the treatment of End Stage Renal Disease (ESRD).

Liver transplantation for a giant mesenchymal hamartoma of the liver in an adult: Case report and review of the literature

Mesenchymal hamartomas of the liver(MHLs) in adults are rare and potentially premalignant lesions, which present as solid/cystic neoplasms. We report a rare case of orthotopic liver transplantation in a patient with a giant MHL. In 2013, a 34-year-old female sought medical advice after a 2-year history of progressive abdominal distention and respiratory distress. Physical examination revealed an extensive mass in the abdomen. Computed tomography(CT) of her abdomen revealed multiple liver cysts, with the diameter of largest cyst being 16 cm × 14 cm. The liver hilar structures were not clearly displayed. The adjacent organs were compressed and displaced. Initial laboratory tests, including biochemical investigations and coagulation profile, were unremarkable. Tumor markers, including levels of AFP, CEA and CA19-9, were within the normal ranges. The patient underwent orthotopic liver transplantation in November 2013, the liver being procured from a 40-year-old man after cardiac death following traumatic brain injury. Warm ischemic time was 7.5 min and cold ischemic time was 3 h. The recipient underwent classical orthotopic liver transplantation. The recipient operative procedure took 8.5 h, the anhepatic phase lasting for 1 h without the use of venovenous bypass. The immunosuppressive regimen includedintraoperative induction with basiliximab and high-dose methylprednisolone, and postoperative maintenance with tacrolimus, mycophenolate mofetil, and prednisone. The recipient's diseased liver weighed 21 kg(dry weight) and measured 41 cm × 32 cm × 31 cm. Histopathological examination confirmed the diagnosis of an MHL. The patient did not experience any acute rejection episode or other complication. All the laboratory tests returned to normal within one month after surgery. Three months after transplantation, the immunosuppressive therapy was reduced to tacrolimus monotherapy, and the T-tube was removed after cholangiography showed no abnormalities. Twelve months after transplantation, the patient remains well and is fulfilling all normal activities. Adult giant MHL is extremely rare. Symptoms, physical signs, laboratory results, and radiographic imaging are nonspecific and inconclusive. Surgical excision of the lesion is imperative to make a definite diagnosis and as a cure. Liver transplantation should be considered as an option in the treatment of a non-resectable MHL.

心脏移植的发展现状和新挑战

心脏移植是终末期心力衰竭患者的首选治疗。供者不足一直以来都是限制心脏移植数量增长的主要问题,随着新技术的不断更新和引入,供者池被不断扩大,比如使用年龄较大的供者、丙型肝炎病毒感染的供者、毒品过量致死的供者或心脏死亡器官捐献(DCD)供者的心脏等。与此同时,高龄、多器官功能不全、机械循环支持及人类白细胞抗原抗体致敏受者的比例近几年明显增加。供者数量的不足、受者状况的复杂化、免疫抑制治疗的个体化管理和远期移植物血管病的防治等都是心脏移植领域面临的挑战。本文通过概述现今全球在扩大供者库、提高受者质量、加强排斥反应的诊治和心脏移植物血管病变的预防等方面的新进展,以期有助于改善在等待或已经接受心脏移植的终末期心力衰竭患者的生存时间和生活质量。

心脏死亡器官捐献供肾与亲属活体捐献供肾的移植效果

目的 探讨心脏死亡器官捐献(donation after cardiac death,DCD)供肾与亲属活体捐献(livingdonor,LD)供肾移植术后短期效果的差异,评估DCD供肾移植的可行性及安全性,以便更好地利用DCD来源供肾。方法 选取2017年12月至2023年1月在临沂市人民医院泌尿外科行肾脏移植术后患者,根据供者的来源分为DCD组和LD组。收集两组的临床资料,并比较两组术后不同时间血肌酐变化及术后并发症等发生情况。结果 共纳入患者70例,其中DCD为50例,LD为20例。两组均恢复顺利,术后2周内血肌酐均降至200μmol/L以下,手术时间、住院时间及术后并发症发生率均差异无统计学意义。但DCD组术后2周内血肌酐水平要高于LD组,其中第1~7天及第9天两组血肌酐水平比较差异有统计学意义(P <0.05)。结论 DCD肾移植效果确切,但在术后短期肾功能恢复与LD供肾存在一定的差异,需要加强术前评估。

小香猪DCD边缘供体模型的构建及其供肾病理学观察

目的建立一种小香猪心脏死亡后器官捐献(donation after cardiac death,DCD)供体模型,并对DCD供肾进行病理学评价。方法7只4~6月龄的雄性小香猪(13~17 kg)分为标准供体对照组(C组,n=3)和DCD组(n=4),两组肌注苯巴比妥钠麻醉诱导后,建立耳缘静脉通道,行血压、心电图和氧饱和度(SaO_(2))监测,同时注射丙泊酚、舒芬太尼强化麻醉诱导效果。C组气管插管后机械通气,丙泊酚、瑞芬太尼和顺阿曲库铵维持麻醉,行开腹术摘取肾脏;DCD组静脉推注肝素(300 IU/kg)抗凝,后注射丙泊酚600 mg和顺阿曲库铵10 mg使猪心跳呼吸停止,待心停跳30 min时摘取肾脏。2组肾脏均切成小块组织,4%多聚甲醛固定,行石蜡包埋,采用HE染色,光镜下观察正常肾脏和DCD边缘供体肾脏的病理结果变化并进行组织损伤评分。结果DCD组共成功建模4只猪在注射过量麻醉药后SaO_(2)下降至80%的平均时间为(3.25±1.89)min,心脏骤停平均时间为(7.75±3.10)min;热缺血30 min后获取的DCD边缘供肾与C组供肾相比,肾小管损伤评分增高(P<0.05),肾小球损伤评分均值增高,但差异无统计学意义。结论采用静脉注射过量丙泊酚和顺阿曲库铵的方法可有效建立猪DCD边缘供体模型。

心脏机械灌注技术的研究现状

高质量的供心是移植成功的先决条件和根本保障,合理的供心保存技术对提升供心质量、改善心脏移植预后具有关键作用。静态冷保存(SCS)是目前移植心脏的标准保存技术,但该技术易造成供心严重的冷缺血损伤,且保存过程中无法评估心脏功能。机械灌注技术作为当前器官保存的重要新型技术,比SCS更符合生理状态,能够在器官保存过程中清除代谢废物、提供代谢需求的基本物质,一定程度延长保存时间、提升保存效果;也能有效评估器官功能,改善心脏移植预后;同时还能修复器官损伤,显著优化器官质量,提高供器官利用率。本文就心脏机械灌注技术的研究现状展开综述。

移植供肺的保存与功能维护

肺移植作为终末期肺病最后的治疗手段,不仅可以明显延长患者的生存时间,还能很大程度改善患者的生活质量。在过去的几十年里,随着外科技术、免疫抑制药和移植术后管理方面的进步,全球肺移植手术量激增。但供肺短缺极大限制了肺移植的发展,需要开发创新方法来扩大供者库。捐献者数量以及潜在供肺的有效保存与功能维护是扩大供者库的关键,供肺质量是保证肺移植受者术后长期生存的重要前提,移植肺的保存与功能维护在保证供肺质量方面尤为重要。本文总结了获取前供肺的管理与维护、供肺获取及移植肺的保存与功能维护的最新进展,以期为临床肺移植的发展提供参考。

扩大标准肾移植术后临床效果分析和器官维护策略探讨

目的分析与比较扩大标准供体(extend criteria donors,ECD)和标准供体(standard criteria donors,SCD)肾移植术后临床效果,探讨ECD的器官维护策略。方法回顾性地分析2014年2月至2022年2月在空军军医大学第一附属医院接受尸体供肾移植且在该中心和西安市人民医院泌尿肾脏病院规律随访的90例受体临床资料,分为ECD组31例和SCD组59例。所有供肾均常规采用单纯低温静置保存。所有受体均应用抗体诱导,常规采用三联免疫抑制治疗(吗替麦考酚酯胶囊/麦考酚钠肠溶片、他克莫司/环孢素、甲泼尼龙)。比较两组受体在肾移植术后1个月、3个月、6个月、1年、2年、3年、5年的血肌酐(serum creatinine,Scr)、并发症的发生情况及人/肾存活率,并进行统计学分析。结果ECD组术后1个月、3个月、6个月、1年、2年、3年、5年的Scr显著高于SCD组(P<0.05)。ECD组AR发生率为12.9%(4/31),SCD组为18.6%(11/59),ECD组和SCD组DGF发生率分别为22.6%(7/31)和16.9%(10/59),肺部感染的发生率分别为12.9%(4/31)和6.8%(4/59),其他感染发生率分别为25.8%(8/31)和15.3%(9/59),持续性蛋白尿分别为22.6%(7/31)和15.3%(9/59),其他并发症的发生率分别为19.4%(6/31)和10.2%(6/59),均无显著性差异(P>0.05)。ECD组1年、3年、5年人/肾存活率分别为93.5/90.3、90.3/83.9、87.1/77.4,SCD组分别为91.5/93.2、89.8/91.5、88.1/89.8,两组差异均无统计学意义(P>0.05)。结论ECD供体肾移植与SCD相比,能够获得一定的临床效果,可以扩大供肾来源,但在长期临床效果尤其是肾功能仍略差于SCD,需要进一步加强ECD待获取器官的有效功能保护和围术期管理。

民用航空超长距离转运供肺肺移植(附6例报告)

目的：探讨应用民用航空超长距离转运心脏死亡器官捐献（DCD）或脑死亡器官捐献（DBD）供肺进行肺移植的可行性。方法回顾性分析2015年2月至3月在南京医科大学附属无锡人民医院应用民用航空超长距离转运供肺施行肺移植手术的6例患者的临床资料。结果供体6例，为 DCD 或 DBD 供体。供肺从取出转运至肺移植手术室共耗时5.0～8.5 h，其中含飞行时间2.0～3.0 h （里程＞1500 km）。受者接受序贯式双肺移植5例，右单肺移植1例。手术过程顺利，肺冷缺血时间7～12 h。受者术后接受呼吸机辅助呼吸，于术后2～4 d 脱机。截止至投稿日，6例受者均恢复良好。结论使用 DCD 或者 DBD 的肺移植供体行序贯式双肺移植手术，若供、受体所在移植单位的两个城市间有直达航班，且飞行时间在3.0 h 内，长距离转运是可行的。

公民逝世后器官捐献供肝质量评估和维护的体会

目的总结公民逝世后器官捐献供肝质量评估和功能维护的经验。方法回顾性分析2012年7月至2015年6月在中山大学附属第三医院器官移植中心成功实施的93例器官捐献供者和87例器官捐献供肝肝移植的临床资料。介绍该中心对供肝质量的评估和功能维护经验,总结器官捐献器官获取和利用的情况,以及接受器官捐献肝移植受体恢复情况。结果供者器官的平均热缺血时间为8 min（1～12 min）,器官切取手术操作顺利,器官切取手术平均耗时为32 min（20～52 min）。93例供体获取了93个肝脏,成功用于肝移植87例,弃用6例（重度脂肪肝3例、肝纤维化2例、肝脏撕裂伤1例）,含2例肝肾联合移植。移植肝功能恢复良好,仅有1例出现原发性移植肝无功能。结论对公民逝世后器官捐献的供者进行早期正确的评估和维护,能够提高移植器官质量,改善移植效果。