76例DCD肝移植病理形态学观察

邓菊庆; 于璐; 刘杰; 廖丽琼; 范方淑; 孙洁; 许赟赟

76例DCD肝移植病理形态学观察

昆明医科大学附属甘美医院病理科

基金项目:

基金：云南省教育厅科学研究基金重点资助项目 (2014Z074);

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出版历程
- 收稿日期: 2017-06-11

Pathological Morphology of 76 Cases of DCD Liver Transplantation

Funds:

基金：云南省教育厅科学研究基金重点资助项目 (2014Z074);

摘要

摘要: 目的观察公民在心脏死亡之后进行器管捐献 (donation after cardiac death, DCD) 供肝的病理形态学变化, 探讨DCD供体肝尤其是脂肪变性供肝在同种异体原位肝移植术中的应用.方法回顾性分析76例DCD供肝在同种异体原位肝移植术中的病理形态学检查结果, 其中脂肪变性分级为无脂肪变性 (S0级) 、轻度 (S1) 、中度 (S2级) 、重度 (S3级) 脂肪变性, 各级例数分别为36例、21例、14例、5例.观察术后3 d、14 d肝、肾功能等主要影响指标及术后早期并发症发生情况.结果与对照组比较, S1、S2级脂肪变性组的肝、肾功能等指标在手术后3 d、14 d与对照组比较差异无统计学意义 (P>0.05) , S3级与对照组相比差异有统计学意义 (P<0.05) ;S1、S2组与对照组比较, 出血、感染、肝动脉栓塞、腹水、败血症等并发症发生率无统计学意义 (P>0.05) , S3组与S1、S2组及对照组比较, 出血、感染、肝动脉栓塞、腹水、败血症等并发症发生率有统计学意义 (P<0.05) .术后14 d患者存活率, 分别为对照组94.4%, S1组、S2组、S3组分别为90.5%、85.7%和60%.结论移植后术后早期主要指标观察, 在慎重选择受体的情况下DCD轻中度脂肪变性供体肝可以用于移植, 对于重度脂肪变性DCD供体肝还是DCD肝移植的难以克服的危险因素, 应该尽量选择不要使用.
- DCD /
- 肝移植 /
- 脂肪变性
Abstract: Objective To observe the pathological morphology changes of DCD donor liver, and to explore the application of DCD donor liver, especially steatosis, donor liver in allogeneic orthotopic liver transplantation (AOLT) . Methods 76 cases of DCD donor liver in AOLT were retrospectively studied, in which the grades of steatosis are classified as no steatosis (S0, n=36 cases) , mild (S1, n=21 cases) , moderate (S2, n= 14 cases) , and severe ones (S3 grade, n=5 cases) . The main influencing indexes of hepatic and renal function and the occurrence of early postoperative complications were observed at 3 days and 14 days after operation. Results Compared with the control group, the hepatic and renal function of S1 and S2 steathepatitis groups were not statistically significant at 3 days and 14 days after operation. The difference of the hepatic and renal function between S3 level and the control group was statistically significant. When compared with the control group, the incidence of complications of S1 and S2 group such as hemorrhage, infection, hepatic artery embolization, ascites and sepsis was not statistically significant (P>0.05) . There was statistically significant difference of the bleeding and infection, Hepatic artery embolism, ascites, sepsis and other complications between S3 level and the control group (P <0.05) . The survival rate of the patients in the 14 days postoperative was 94.4% in the control group and 90.5%, 85.7% and 60% in S1 group, S2 group and S3 group respectively. Conclusions Mild and moderate steatosis DCD donor liver can be used for transplantation in the case of careful selection. But it is difficult to overcome the risk factors for severe steatosis DCD donor liver for transplantation. So severe steatosis DCD donor liver should try to not to use.
- DCD /
- Liver transplantation /
- Steatosis

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参考文献(8)

[1]	[1]NANASHIMA A, PILLAY P, VERRAN D J, et al.Analysis of initial poor graft function after orthotopie liver transplantation:experience of an Australian single liver transplantation center[J].Transplant Proc, 2002, 34 (4) :1231-1235.
[2]	[2]MCLEAN K, CAMILLERI-BRENNAN J, et al.Decision modelling donation after Circulatory Death (DCD) Liver Transplantation[J].International Journal of Surgery, 2016, 36 (Suppl 1) :S31-S132.
[3]	[3]FRONGILLO F, AVOLIO A W, NURE E, et al.Quantification of degree of steatosis in extended criteria donor donor grafts with standardized histologic techniques:implication for graft survival[J].Transplant Proc, 2009, 41 (4) :1268-1272.
[4]郑飞波, 蒋文涛.脂肪变性供肝对成人肝移植早期预后的影响[J].中华普通外科杂志, 2016, 31 (3) :201-203.
[5]叶啟发, 明英姿, 赵杰等.64例子脂肪变性供肝临床肝移植疗效分析.[J]中华肝胆外科杂志, 2013, 19 (2) :105-107.
[6]	[6]MATEO R, CHO Y, SINGH G, et al.Risk factors for graft survival after liver transplantation from donation after cardiac death donors:An analysis of OPTN/UNOS data[J].AM J Transplant, 2006, 6 (4) :791-796.
[7]	[7]CHAN E Y, OLSON L C, KISTHARD J A, et al.Ischemic cholangiopathy following liver transplantation from donation after cardiac death donors[J].Liver transplantation, 2008, 14 (5) :604-610.
[8]	[8]FOLEY D P, FERNANDEZ L A, LEVERSON G, et al.Biliary complications after liver transplantation from donation after cardiac death donors:an analysis of risk factors and long-term outcomes from a single center[J].Ann Surg, 2011, 253 (4) :817-825.

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