儿童及高龄边缘供肝在成年肝移植中的临床应用初步经验
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摘要
目的 :探讨公民逝世后器官捐献(DCD)与年龄相关的边缘供肝临床肝移植应用经验。方法 :对南京医科大学第一附属医院2013年12月至2015年10月3例与年龄相关的边缘供肝应用于肝移植的临床情况进行回顾分析,包括供受者双方的临床资料及受者术后短期恢复情况。结果:3例供者其中2例实施中国Ⅲ类即脑-心双死亡(DBCD)器官捐献,另外1例实施中国Ⅱ类器官捐献。3例供者中1例为7岁儿童,另外2例分别为79岁老年男性和83岁老年女性。3例肝移植受者术后恢复顺利,肝功能恢复良好,其中儿童供肝肝移植患者术后1个月出现幻觉、幻听及被害妄想等神经精神症状,经治疗痊愈。结论:本研究在一定程度上说明儿童和老年边缘供肝只要科学评估和合理应用于合适的受体一样可以获得良好的效果,年龄不应该成为独立的肝移植禁忌证,在做好充分评估的基础上,与年龄相关的边缘供肝应用于肝移植具有较高的可行性。
Objective:To explore the application of Donation after citizen's death(DCD)and age-related marginal donor for liver transplantation in clinical liver transplantation. Methods:From December 2013 to October 2015,3 cases of DCD age-related marginal donors for liver transplantation were included in the Liver Transplantation Center,the First Affiliated Hospital of Nanjing Medical University. The clinical situation of liver transplantation was analyzed,retrospectively,including clinical data of both donors,and recipients, and short-term recovery of recipients. Results:Among the 3 cases,2 cases were performed by Chinese Ⅲ DCD ethical standard,and 1 cases was performed by Chinese Ⅱ DCD ethical standard. Among the 3 cases,one case was 7 years old,the other two cases were 79 years old and 83 years old. Three recipients recovered smoothly and liver function recovered well. The recipients by children liver appeared hallucinations,auditory hallucination and delusion of neuropsychiatric symptoms after 1 month,and healed after treatment. Conclusion:The study suggests that to some extent,as long as the scientific evaluation and reasonable application of the appropriate receptors,the liver transplantation of DCD marginal donors can obtain good results. Age should not be an independent taboo for liver transplant. On the basis of adequate assessment,the age-related marginal donor for liver transplantation is feasible.
Objective:To explore the application of Donation after citizen's death(DCD)and age-related marginal donor for liver transplantation in clinical liver transplantation. Methods:From December 2013 to October 2015,3 cases of DCD age-related marginal donors for liver transplantation were included in the Liver Transplantation Center,the First Affiliated Hospital of Nanjing Medical University. The clinical situation of liver transplantation was analyzed,retrospectively,including clinical data of both donors,and recipients, and short-term recovery of recipients. Results:Among the 3 cases,2 cases were performed by Chinese Ⅲ DCD ethical standard,and 1 cases was performed by Chinese Ⅱ DCD ethical standard. Among the 3 cases,one case was 7 years old,the other two cases were 79 years old and 83 years old. Three recipients recovered smoothly and liver function recovered well. The recipients by children liver appeared hallucinations,auditory hallucination and delusion of neuropsychiatric symptoms after 1 month,and healed after treatment. Conclusion:The study suggests that to some extent,as long as the scientific evaluation and reasonable application of the appropriate receptors,the liver transplantation of DCD marginal donors can obtain good results. Age should not be an independent taboo for liver transplant. On the basis of adequate assessment,the age-related marginal donor for liver transplantation is feasible.
引文
[1]Adam R,Hoti E.Liver transplantation:the current situation[J].Semin Liver Dis,2009,29(1):3-18
[2]Gao K,Wang JF,Wei BJ,et al.Interventional treatment of hepatic artery complications after liver transplantation[J].Chin J Interv Imaging Ther,2012,9(1):7-10
[3]刘振生,赵红川,耿小平.快速病理检查在供肝选择中的研究进展[J].中华器官移植杂志2014,35(12):
[4]Sass DA,Reich DJ.Liver transplantation in the 21 st century:expanding the donor options[J].Gastroenterol Clin North Am,2011,40(3):641-658
[5]Attia M,Siwa MA,Mirza DF.The marginal liver donor-an update[J].Transpl Int,2011,21(7):713-724
[6]Feng S,Goodrich NP,Bragg-Gresham JL,et al.Characteristics associated with liver graft failure:the concept of a donor risk index[J].Am J Transplant,2006,6(4):783-785
[7]Kiuchi T,Tanaka K,Ito T,et al.Small-for-size graft in living donor liver transplantation:how far Should we go?[J].Liver Transpl,2003,9(9):329-335
[8]Nishizaki T,Ikegami T,Hiroshige S,et al.Small graft for living donor liver transplantation[J].Ann Surg,2001,233(4):575-580
[9]Ben-Haim M,Emre S,Fishbein TM,et al.Critical graft size in adult-to-adult living donor liver transplantation:impact of the recipient s disease[J].Liver Transpl,2001,7(11):948-953
[10]Emre S,Soejima Y,Altaca G,et al.Safety and risk of using pediatric donor livers in adult liver transplantation[J].Liver Transpl,2001,7(1):41-47
[11]Kawasaki S,Makuuchi M,Matsunami H,et al.Living related liver transplantation in adults[J].Ann Surg,1998,227(2):269-274
[12]Tanaka K,Ogura Y.“Small-for-size graft”and“small-forsize syndrome”in living donor liver transp1antation[J].Yonsei Med J,2004,45(6):1089-1094
[13]Suehiro T,Shimada M,Kishikawa K,el al.Effect of intraportal infusion to improve small for size graft injury in living donor adult liver transplantation[J].Transpl Int,2005,18(8):923-928
[14]Grande L,Rull A,Rimola A,et al.Outcome of patients undergoing orthotopic liver transplantation with elderly donors(over 60 years)[J].Transplant Proc,1997,29(8):3289-3290
[15]Grazi GL,Cescon M,Ravaioli M,et al.A revised consideration on the use of very aged donors for liver transplantation[J].Am J Transplant,2001,1(1):61-68
[16]Mazziotti A,Cescon M,Grazi GL,et al.Successful liver transplantation using an 87 year-old donor[J].Hepatogastroenterology,1999,46(27):1819-1822
[17]Strasberg SM,Howard TK,Molmenti EP,et al.Selecting the donor liver:risk factors for poor function after orthotopic liver transplantation[J].Hepatology,1994,20(4 Pt1):829-838
[18]Adam R,Sanchez C,Astarcioglu I,et al.Deleterious effect of extended cold ischemia time on the posttransplant outcome of aged livers[J].Transplant Proc,1995,27(1):1181-1183
[19]Nardo B,Masetti M,Urbani L,et al.Liver transplantation from donors aged 80 years and over:pushing the limit[J].Am J Transplant,2004,4(7):1139-1147
[20]Borchert D,Glanemann M,Mogl M,et al.Older liver graft transplantation,cholestasis and synthetic graft function[J].Transpl Int,2005,18(6):709-712
[21]Briceo J,Marchal T,Padillo J,et al.Influence of marginal donors on liver preservation injury[J].Transplantation,2002,74(4):522-526
[22]巫林伟,何晓顺.供肝短缺形势下的我国肝移植策略[J].中华移植杂志(电子版),2009,3(3):179-183
[2]Gao K,Wang JF,Wei BJ,et al.Interventional treatment of hepatic artery complications after liver transplantation[J].Chin J Interv Imaging Ther,2012,9(1):7-10
[3]刘振生,赵红川,耿小平.快速病理检查在供肝选择中的研究进展[J].中华器官移植杂志2014,35(12):
[4]Sass DA,Reich DJ.Liver transplantation in the 21 st century:expanding the donor options[J].Gastroenterol Clin North Am,2011,40(3):641-658
[5]Attia M,Siwa MA,Mirza DF.The marginal liver donor-an update[J].Transpl Int,2011,21(7):713-724
[6]Feng S,Goodrich NP,Bragg-Gresham JL,et al.Characteristics associated with liver graft failure:the concept of a donor risk index[J].Am J Transplant,2006,6(4):783-785
[7]Kiuchi T,Tanaka K,Ito T,et al.Small-for-size graft in living donor liver transplantation:how far Should we go?[J].Liver Transpl,2003,9(9):329-335
[8]Nishizaki T,Ikegami T,Hiroshige S,et al.Small graft for living donor liver transplantation[J].Ann Surg,2001,233(4):575-580
[9]Ben-Haim M,Emre S,Fishbein TM,et al.Critical graft size in adult-to-adult living donor liver transplantation:impact of the recipient s disease[J].Liver Transpl,2001,7(11):948-953
[10]Emre S,Soejima Y,Altaca G,et al.Safety and risk of using pediatric donor livers in adult liver transplantation[J].Liver Transpl,2001,7(1):41-47
[11]Kawasaki S,Makuuchi M,Matsunami H,et al.Living related liver transplantation in adults[J].Ann Surg,1998,227(2):269-274
[12]Tanaka K,Ogura Y.“Small-for-size graft”and“small-forsize syndrome”in living donor liver transp1antation[J].Yonsei Med J,2004,45(6):1089-1094
[13]Suehiro T,Shimada M,Kishikawa K,el al.Effect of intraportal infusion to improve small for size graft injury in living donor adult liver transplantation[J].Transpl Int,2005,18(8):923-928
[14]Grande L,Rull A,Rimola A,et al.Outcome of patients undergoing orthotopic liver transplantation with elderly donors(over 60 years)[J].Transplant Proc,1997,29(8):3289-3290
[15]Grazi GL,Cescon M,Ravaioli M,et al.A revised consideration on the use of very aged donors for liver transplantation[J].Am J Transplant,2001,1(1):61-68
[16]Mazziotti A,Cescon M,Grazi GL,et al.Successful liver transplantation using an 87 year-old donor[J].Hepatogastroenterology,1999,46(27):1819-1822
[17]Strasberg SM,Howard TK,Molmenti EP,et al.Selecting the donor liver:risk factors for poor function after orthotopic liver transplantation[J].Hepatology,1994,20(4 Pt1):829-838
[18]Adam R,Sanchez C,Astarcioglu I,et al.Deleterious effect of extended cold ischemia time on the posttransplant outcome of aged livers[J].Transplant Proc,1995,27(1):1181-1183
[19]Nardo B,Masetti M,Urbani L,et al.Liver transplantation from donors aged 80 years and over:pushing the limit[J].Am J Transplant,2004,4(7):1139-1147
[20]Borchert D,Glanemann M,Mogl M,et al.Older liver graft transplantation,cholestasis and synthetic graft function[J].Transpl Int,2005,18(6):709-712
[21]Briceo J,Marchal T,Padillo J,et al.Influence of marginal donors on liver preservation injury[J].Transplantation,2002,74(4):522-526
[22]巫林伟,何晓顺.供肝短缺形势下的我国肝移植策略[J].中华移植杂志(电子版),2009,3(3):179-183