Liver transplant using donors after unexpected cardiac death:: Novel preservation protocol and acceptance criteria
Liver transplant using donors after unexpected cardiac death:: Novel preservation protocol and acceptance criteria
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DOI：
10.1111/j.1600-6143.2007.01846.x
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发表时间：
2007-07-01
影响因子：
8.8
通讯作者：
Garcia-Valdecasas, J. C.
中科院分区：
文献类型：
--
作者：
Fondevila, C.;Hessheimer, A. J.;Garcia-Valdecasas, J. C.
心源性死亡（DCD）供体在捐献前发生不可逆的心脏骤停。我们描述了我们对心脏骤停意外的DCD进行肝移植的经验，没有在取消通气支持后，我们使用常温体外膜肺氧合（NECMO）维持通气支持。一个潜在的捐赠者在医院外心脏骤停，并在持续心肺复苏（CPR）下被带到医院。捐献者被宣布死亡，并被放置在心脏压缩机上。将股血管插管并连接至心肺转流（CPB）以建立NECMO。在整个NECMO过程中监测血液参数和CPB泵流量，持续至冷保存。从2002年4月至2006年5月，40个潜在的DCD肝脏中有10个被移植。只有一个移植物失去了原发性无功能（PNF），另一个肝动脉血栓形成。移植后肝功能良好。某些参数，如CPR和NECMO时间，NECMO期间的肝转氨酶和供体年龄，确定DCD肝移植物的活力，并用于建立其验收标准。尽管被认为是边缘性的，但如果采用严格的验收标准，并且在恢复前使用NECMO维持，则非预期DCD可能代表移植用活肝的重要来源。
Donors after cardiac death (DCD) suffer irreversible cardiac arrest prior to donation. We describe our liver transplant experience with DCD whose cardiac arrest is unexpected, not following the removal of ventilatory support, whom we maintain with normothermic extracorporeal membrane oxygenation (NECMO). A potential donor goes into cardiac arrest outside the hospital and is brought to the hospital under continuous cardiopulmonary resuscitation (CPR). The donor is declared dead and placed on a cardiocompressor. Femoral vessels are cannulated and connected to cardiopulmonary bypass (CPB) to establish NECMO. Blood parameters and CPB pump flow are monitored throughout NECMO, which is continued until cold preservation. From April 2002 to May 2006, 10 of 40 potential DCD livers were transplanted. Only one graft was lost to primary nonfunction (PNF) and another to hepatic artery thrombosis. Posttransplant hepatic function was good. Certain parameters, such as CPR and NECMO times, hepatic transaminases during NECMO, and donor age, determined the viability of DCD liver grafts and were used to establish criteria for their acceptance. Though considered marginal, unexpected DCD can represent an important source of viable livers for transplant if strict acceptance criteria are employed and they are maintained with NECMO prior to recovery.