公民逝世后器官捐献供肝保护及功能评估临床分析

Clinical analysis on donor liver protection and function evaluation for organ donation after citizen's death

  • 摘要:
      目的  总结公民逝世后器官捐献供肝保护及功能评估的初步经验。
      方法  回顾性分析35例公民逝世后器官捐献供者和33例受者的临床资料。总结供肝获取情况和受者预后情况;根据供者器官获取前的血清钠离子水平(血清钠),将相应受者分为血清钠<155 mmol/L组、血清钠155~160 mmol/L组和血清钠161~180 mmol/L组,比较3组受者术后早期移植肝功能不全的发生率。
      结果  35例供者中,中国标准二类27例,中国标准三类8例,实施肝移植33例,余2例肝脏有淤血性肝硬化改变,弃用。33例肝移植受者中,30例恢复顺利,术后7~14 d肝功能逐渐恢复正常,长期门诊随访移植肝功能基本正常;3例受者死亡,其中2例死于门静脉血栓形成,1例死于肺部感染合并多器官功能衰竭。血清钠<155 mmol/L组、血清钠155~160 mmol/L组和血清钠161~180 mmol/L组受者术后早期移植肝功能不全的发生率依次为18%、23%和4/5,其中,血清钠161~180 mmol/L组明显高于血清钠<155 mmol/L组(P<0.05)。
      结论  对公民逝世后器官捐献供肝功能进行及时、准确的评估和维护是提高供肝利用率、保证供肝功能和取得较好移植效果的关键因素。

     

    Abstract:
      Objective  To summarize the preliminary experience of donor liver protection and function evaluation for organ donation after citizen's death.
      Methods  Clinical data of 35 donors from organ donation after citizen's death and 33 recipients were retrospectively analyzed. Donor liver procurement and clinical prognosis of the recipients were summarized. According to serum level of sodium ion (serum sodium) before organ procurement, all recipients were divided into the serum sodium < 155 mmol/L, 155-160 mmol/L and 161-180 mmol/L groups. The incidence of liver graft dysfunction early after liver transplantation was statistically compared among three groups.
      Results  In 35 donors, 27 cases were Chinese type Ⅱ and 8 cases were Chinese type Ⅲ. Thirty-three donor livers were used for liver transplantation, and the remaining 2 cases of donor livers were excluded due to congestive cirrhosis. In 33 liver transplantation recipients, 30 cases were successfully recovered. The liver function was gradually restored at postoperative 7-14 d, and normal liver function was obtained during long-term follow-up. Postoperatively, 3 recipients died including 2 cases dying from portal vein thrombosis and 1 case from pulmonary infection complicated with multiple organ failure. The incidence of early liver graft dysfunction of the recipients after liver transplantation was 18%, 23% and 4/5 in the serum sodium < 155 mmol/L, 155-160 mmol/Land 161-180 mmol/L groups, respectively. Statistical significance was observed between the 161-180 mmol/L and < 155 mmol/L groups (P < 0.05).
      Conclusions  Timely protection of donor liver, accurate evaluation and maintenance of liver function play a pivotal role in enhancing the utilization rate of donor liver, maintaining liver function and yielding good efficacy for transplantation.

     

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