摘要
目的评价儿童脑死亡后器官捐献供肝行劈离式肝移植的可行性和安全性.方法回顾性分析8例在天津市第一中心医院器官移植中心完成的供者年龄在2.7~7.0岁之间的劈离式肝移植儿童受者的临床资料.评估供、受者信息、围手术期特点、术后早期恢复情况,术后并发症以及移植物和受者存活率.结果 3例供肝劈离过程在体外完成,1例在体内完成,所有供肝均被分为左外叶和右三叶.受者为4.7~105.5月龄的儿童患者.8例受者术后平均随访时间为(8.1±0.6)个月,移植物和受者存活率均为100%.随访期末所有受者移植肝功能均维持在正常范围.2例受者接受冷缺血时间较长的供肝,术后肝功能恢复较为缓慢,肝脏穿刺活检提示供肝缺血缺氧性改变.1例受者术后早期出现门静脉狭窄,行经皮肝穿刺门静脉球囊扩张成型术后好转.8例受者中5例术后出现巨细胞病毒感染,使用更昔洛韦治疗后血清病毒学指标转阴.本研究中使用的最年轻供者年龄为2.7岁,接受此供者供肝的2例受者预后良好.结论在严格的供受者筛选标准指导下,2.7~7.0岁儿童脑死亡后器官捐献供肝行劈离式肝移植可取得理想的临床疗效.
Objective To evaluate the feasibility and safety of using pediatric donation after brain death donors during split liver transplantation .Methods The clinical data were retrospectively reviewed for 8 pediatric recipients undergoing split liver transplantation with a donor age of 2 .7-7 years .The clinical characteristics of donors/recipients ,perioperative course ,postoperative recovery and complications along with graft and recipient survival rate were analyzed .Results The split procedure was performed ex situ (n=3) and in situ (n=1),all liver grafts were split into left lateral lobes and extended right lobes . The recipients were children aged 4 .7-105 .5 months . The mean follow-up period was (8 .1 ± 0 .6) months and the graft/recipient survival rates approached 100%. Graft functions remained normal in all recipients at the end of follow-ups .Two recipients undergoing liver grafting with long cold ischemia time exhibited slower recovery of graft function .Pathological examination of graft biopsy indicated ischemic and hypoxic changes .Portal vein stenosis occurred in one recipient .Percutaneous transhepatic portal vein balloon dilatation was performed and the recipient recovered well .Cytomegalovirus infection occurred in 5/8 recipients and serum virological marker returned to normal after ganciclovir therapy . The youngest donor age was 2 .7 years and both recipients of donor liver recovered well .Conclusions Split liver transplantation with a donor age of 2 .7-7 .0 years may achieve ideal clinical outcomes in well-matched donors and recipients .
作者
宋卓伦
马楠
董冲
孟醒初
孙超
覃虹
韩潮
杨洋
张复波
郑卫萍
高伟
Song Zhuolun;Ma Nan;Dong Chong;Meng Xingchu;Sun Chao;Qin Hong;Han Chao;Yang Yang;Zhang Fubo;Zheng Weiping;Gao Wei(Organ Transplantation Center,First Municipal Central Hospital,Tianjin 300192,China)
出处
《中华器官移植杂志》
CAS
北大核心
2019年第7期387-391,共5页
Chinese Journal of Organ Transplantation
基金
天津市卫生行业重点攻关项目(16KG107)
天津市器官移植临床医学研究中心项目(15ZXLCSY00070)
天津市自然科学基金(18JCYBJC44400).
关键词
肝移植
脑死亡
儿童
Liver transplantation
Brain death
Child
