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中国移植器官保护专家共识(2022版)

中国肝移植注册中心, 国家肝脏移植质控中心, 国家人体捐献器官获取质控中心, 等. 中国移植器官保护专家共识(2022版)[J]. 器官移植, 2022, 13(2): 144-160. doi: 10.3969/j.issn.1674-7445.2022.02.002
引用本文: 中国肝移植注册中心, 国家肝脏移植质控中心, 国家人体捐献器官获取质控中心, 等. 中国移植器官保护专家共识(2022版)[J]. 器官移植, 2022, 13(2): 144-160. doi: 10.3969/j.issn.1674-7445.2022.02.002
China Liver Transplant Registry, National Center for Healthcare Quality Management in Liver Transplant, National Quality Control Center for Human Donated Organ Procurement, et al. Chinese expert consensus on organ protection of transplantation (2022 edition)[J]. ORGAN TRANSPLANTATION, 2022, 13(2): 144-160. doi: 10.3969/j.issn.1674-7445.2022.02.002
Citation: China Liver Transplant Registry, National Center for Healthcare Quality Management in Liver Transplant, National Quality Control Center for Human Donated Organ Procurement, et al. Chinese expert consensus on organ protection of transplantation (2022 edition)[J]. ORGAN TRANSPLANTATION, 2022, 13(2): 144-160. doi: 10.3969/j.issn.1674-7445.2022.02.002

中国移植器官保护专家共识(2022版)

doi: 10.3969/j.issn.1674-7445.2022.02.002
基金项目: 

国家自然科学基金 81721091

海南省重大科技计划项目 ZDKJ2019009

济南微生态生物医学省实验室科研项目 JNL-2022002A

济南微生态生物医学省实验室科研项目 JNL-2022023C

浙江省基础公益研究计划 LGF21H030006

中国医学科学院创新单元项目 2019-I2M-5-030

国家传染病重大专项 2017ZX10203205

详细信息
  • 中图分类号: R617

  • 摘要: 器官移植是治疗终末期器官衰竭最有效的手段,公民逝世后自愿捐献器官已成为我国移植器官的唯一来源。在临床实践中,移植器官保护技术对提升移植器官质量,改善受者预后发挥重要作用。中国医师协会器官移植医师分会、中华医学会外科学分会器官移植学组及中国肝移植注册中心科学委员会组织专家,基于国内外移植器官保护的基础研究与临床实践,根据牛津循证医学证据分级和GRADE推荐意见系统,针对肝脏、肾脏、胰腺、小肠、心脏、肺脏移植器官编写了《中国移植器官保护专家共识(2016版)》。近期,在国家肝脏移植注册中心、国家创伤医学中心、国家人体捐献器官获取质控中心、国家骨科与运动康复临床医学研究中心及国家肝脏移植质控中心的支持下,结合近年来国内外器官移植及器官保护临床实践与研究进展进行总结,形成《中国移植器官保护专家共识(2022版)》。本共识重点更新了相关器官获取、保存、转运、质量评估在临床实践中的技术进展及相应循证医学研究证据。此外,还增加了包括以肢体移植为主的复合组织移植的内容,旨在促进临床器官移植工作科学、规范开展。

     

  • 表  1  循证医学证据分级

    Table  1.   Grading of evidence based medicine

    证据级别 定义
    同质RCT的系统评价
    单个RCT(可信区间窄)
    全或无病案系列研究
    同质队列研究的系统评价
    单个队列研究(包括低质量RCT,如随访率 < 80%)
    结果研究,生态学研究
    同质病例对照研究的系统评价
    单个病例对照研究
    病例系列研究(包括低质量队列及病例对照研究)
    基于经验未严格论证的专家意见
    下载: 导出CSV

    表  2  腹部器官获取及肝脏保存修复推荐意见

    Table  2.   Recommendations for abdominal organ acquisition and liver preservation and repair

    序号 建议 证据级别 推荐强度
    1 腹部器官获取及保存过程中应尽量缩短冷缺血和热缺血时间
    2 目前供肝保存以SCS为主
    3 UW液和HTK液是目前供肝保存最常用的保存液,二者保存效果接近
    4 HOPE可减少DCD供肝肝移植术后非吻合性胆道并发症发生
    5 NMP可促进肝移植术后肝功能恢复、改善移植预后
    6 机械灌注可在供肝保存修复及转运过程中动态监测、评价供肝质量
    下载: 导出CSV

    表  3  肾脏保存修复推荐意见

    Table  3.   Recommendations for kidney preservation and repair

    序号 建议 证据级别 推荐强度
    1 UW液、HTK液、Marshall液、Celsior液、HC-A Ⅱ液以及IGL-1液对供肾SCS具有良好的效果
    2 过长的冷缺血时间与肾移植术后不良预后密切相关,已经经历了热缺血的供肾,应缩短供肾冷保存时间
    3 HMP显著降低肾移植术后DGF发生率,并有助于改善移植物存活率
    4 KPS-1液应用于HMP对供肾具有较好的保护效果
    5 超长冷缺血时间仍是HMP保存供肾发生DGF的独立危险因素,应适当控制HMP保存时间
    6 肾移植术前NMP能显著改善冷保存ECD或DCD供肾质量、降低术后DGF发生率
    下载: 导出CSV

    表  4  胰腺保存修复推荐意见

    Table  4.   Recommendations for pancreas preservation and repair

    序号 建议 证据级别 推荐强度
    1 移植胰腺多采用SCS,冷缺血时间一般不超过12 h,保存液目前多选用UW液
    2 机械灌注对改善胰腺功能具有一定价值,相关研究尚处于临床前阶段
    3 胰岛移植中,胰岛多在UW液中低温(4 ℃)保存
    4 胰岛体外培养的时间一般不超过72 h
    下载: 导出CSV

    表  5  小肠保存修复推荐意见

    Table  5.   Recommendations for small intestine preservation and repair

    序号 建议 证据级别 推荐强度
    1 冷保存前应常规进行血管和肠管(低压)灌洗
    2 SCS是小肠保存最常用的方法,小肠冷保存时间一般不超过6~9 h
    3 UW液是灌洗及SCS应用最广泛的保存液,近来也有使用HTK液及IGL-1液进行保存
    4 机械灌注在小肠移植领域目前仍处于临床前阶段,有待进一步临床验证
    下载: 导出CSV

    表  6  心脏保存修复推荐意见

    Table  6.   Recommendations for heart preservation and repair

    序号 建议 证据级别 推荐强度
    1 供心移植主要采用DBD
    2 SCS是目前供心保存应用最普遍的方法,临床上建议SCS时间一般不超过8 h,尽量在4 h以内
    3 NMP在心脏保存方面展示出一定的潜力,尤其在边缘供心的保存和修复方面,但仍需更多临床实验进行验证
    4 供心保存液推荐UW液、HTK液以及Celsior液,新型保存液效果有待进一步临床验证
    下载: 导出CSV

    表  7  肺脏保存修复推荐意见

    Table  7.   Recommendations for lung preservation and repair

    序号 建议 证据级别 推荐强度
    1 供肺获取前应对供者进行包括氧合指数、年龄、吸烟史、胸部影像、支气管镜检查及痰涂片镜检等供肺质量评估
    2 供肺获取时,尽量缩短热缺血时间;肺动脉灌注压力10~15 mmHg,灌注量60 mL/kg,每根肺静脉逆行灌注250 mL;灌注液温度4~8 ℃;获取时呼吸机FiO2维持在50%,PEEP为5 cmH2O,压力 < 20 cmH2O,潮气量6~8 mL/kg,离体供肺需维持约50%的充气膨胀状态
    3 离体供肺推荐4~8 ℃下基于细胞外液的静态冷保存(Perfadex,R-LPD液等),尽量缩短冷缺血时间
    4 EVLP等供肺离体机械灌注技术具有修复供肺、改善供肺功能,增加供肺利用率,延长供肺冷缺血时间,推荐在有条件的中心开展
    下载: 导出CSV

    表  8  肢体获取与保存修复推荐意见

    Table  8.   Recommendations for limb acquisition, preservation and repair

    序号 建议 证据级别 推荐强度
    1 肢体获取时应轻柔操作,避免机械损伤
    2 尽量保存受者的皮肤,减少供者皮肤免疫排斥反应
    3 推荐供肢离断前应用UW液进行灌注
    4 目前肢体移植保存以SCS为主
    5 机械灌注在肢体移植领域目前仍处于临床前阶段,有待于进一步临床验证
    6 灌注液推荐UW液或HTK液,新型灌注液效果有待进一步临床验证
    下载: 导出CSV
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出版历程
  • 收稿日期:  2022-02-14
  • 网络出版日期:  2022-03-18
  • 刊出日期:  2022-03-15

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