Ischemic cholangiopathy after liver transplantation from controlled non-heart-beating donors-a single-center experience
Ischemic cholangiopathy after liver transplantation from controlled non-heart-beating donors-a single-center experience
复制标题
DOI：
10.1016/j.transproceed.2007.08.081
复制
发表时间：
2007-11-01
影响因子：
0.9
通讯作者：
Talbot, D.
中科院分区：
文献类型：
--
作者：
Kaczmarek, B.;Manas, M. D.;Talbot, D.
背景。先前的报道表明，来自受控非心脏供体（NHBD）的肝脏作为长期热缺血的并发症，与原位肝移植（OLT）的原发性衰竭和缺血性胆管病的发生率较高相关。本研究回顾了1999年至2006年供者的年龄特征、肝功能检查、心脏骤停前（1WITa）和心脏骤停后（1WITb）的热缺血时间、冷缺血时间和移植结果。11例从“理想”供者获得的NHBD肝脏被移植，除了1例老年供者（73岁）。11例患者中发生胆管病3例（27%）。没有原发性移植物无功能发作，但有一名受者表现出原发性移植物功能障碍。两名受者死亡：一名死于胆道并发症伴脓毒症（长CIT bb10小时，脂肪肝），另一名死于吸入性肺炎和缺氧性脑损伤，肝功能正常。1例受者在OLT后6个月因缺血性胆管病（1例，45分钟）需要再次移植，结果良好。其他8例患者存活（观察期72 - 14个月），其中6例肝功能正常，1例活检证实胆道缺血，1例复发性原发性硬化性胆管炎，活检未见胆道缺血改变。同期移植的164例心脏供体受者中，发生胆道并发症27例（16%），其中瘘12例，吻合口狭窄15例。NHBD是肝脏的良好来源，具有合理的早期结果。为了避免晚期并发症，特别是缺血性胆管病，应谨慎使用这些器官以及严格的供体和缺血时间标准。
Background. Previous reports have shown that livers from controlled non-heartbeating-donors (NHBD) are associated with higher rates of primary failure and ischemic cholangiopathy of orthotopic liver transplantation (OLT) as a complication of the prolonged warm ischemia.Methods. This retrospective review of activities from 1999 to 2006 examined donor characteristics of age, liver function tests, warm ischemic time before (1WITa) and after cardiac arrest (1WITb), cold ischemic time (CIT) and transplant results.Results. Eleven NHBD retrieved livers were transplanted from "ideal" donors except for one elderly donor (73 years). Of the 11 recipients, 3 developed biliary cholangiopathy (27%). There were no episodes of primary graft nonfunction, but one recipient displayed primary graft dysfunction. Two recipients died: one due to biliary complications with sepsis (long CIT >10 hours, fatty liver), and the other due to aspiration pneumonia and hypoxic brain damage with normal liver function. One recipient required retransplantation owing to ischemic cholangiopathy (1WITb 45 min) at 6 months after OLT with a good result. The other eight recipients are alive (observation period 72 to 14 months) including six with normal liver function, one with biopsyproven biliary ischemia and one with recurrent primary sclerosing cholangitis without biliary ischemic changes on biopsy. Among 164 heart-beating donors recipients transplanted in the same period, biliary complications occurred in 27 patients (16%), of whom 12 were leaks and 15 anastomotic strictures.Conclusion. NHBD were a good source for livers with reasonable early results. To avoid late complications especially ischemic cholangiopathy, caution is urged with the use of these organs as well as strict donor and ischemic time criteria.