摘要
目的探讨高龄扩大标准供者供肝在成人肝移植应用的临床疗效。方法回顾分析2015年1月至2018年6月复旦大学附属华山医院肝移植中心199例成人肝移植供、受者临床资料,按供者年龄分为高龄组(≥60岁)和适龄组(<60岁),术后随访1年,比较两组预后。我们依据供肝脂肪浸润程度将高龄组分为低脂肪肝(<20%)、高脂肪肝(≥20%)两组,比较两组预后。结果接受高龄和适龄组供肝的受者肝移植术后转氨酶初值、峰值和恢复正常时间,总胆红素峰值和恢复正常时间,γ-谷氨酰转肽酶峰值和恢复正常时间,碱性磷酸酶峰值和恢复正常时间,国际标准化比值峰值和恢复正常时间,乳酸峰值,术后住院时间,移植物无功能,以及术后1年内胆道和血管并发症,急、慢性排斥反应,移植物存活率等指标差异均无统计学意义。高龄组中的低脂肪肝和高脂肪肝两组的受者术后天冬氨酸转氨酶峰值、丙氨酸转氨酶峰值及恢复正常时间、总胆红素峰值、γ-谷氨酰转肽酶峰值、乳酸峰值、术后住院时间、移植物功能丧失的差异有统计学意义,高脂肪肝组上述指标明显较差。此外,术后1年高脂肪肝组有较高排斥反应率,两组胆道和血管并发症差异无统计学意义。高龄高脂肪肝组受者有4例出现移植后围手术期移植肝功能丧失,其中2例进行二次移植顺利出院,另外2例受者死亡。结论在综合评估供肝状况及合理匹配受者的前提下,能够安全使用高龄扩大标准供者供肝,并能取得良好的临床效果。其中,高龄扩大标准供者的高脂肪浸润肝仍应谨慎使用,且使用升压药物后,高血钠和冷缺血时间长也是高龄扩大标准供者供肝成败的重要影响因素。
Objective To explore the clinical efficacies of applying aged marginal donor liver.Methods From January 2015 to June 2018,clinical data were retrospectively analyzed for 199 adult liver transplantation donors and recipients.They were divided into two groups of aged(≥60 years)and appropriate age(<60 years).The prognosis of two groups was compared after a follow-up period of 1 year.And the aged group was further assigned into lower and higher fat infiltration groups according to the degree of fat infiltration in donor liver and compared the prognosis of two groups.ResultsNo significant differences existed in initial,peak value and recovery time of transaminase(AST/ALT),peak value and recovery time of total bilirubin,glutamyl transpeptidase,alkaline phosphatase,international normalized ratio(INR),peak value of lactate,postoperative hospital stay,graft dysfunction,biliary/vascular complications,acute/chronic rejection or graft survival rate between aged and appropriate age groups post-transplantation.The aged group was further divided into lower and higher fat infiltration groups according to the fat infiltration rate(<20%,≥20%).And significant inter-group differences existed in peak value and recovery time of AST/ALT,peak value of total bilirubin,glutamyl transpeptidase,lactate,postoperative hospital stay and graft dysfunction.The above parameters were significantly worse in higher fat infiltration group.Also the rejection rate was higher in high group at 1 year post-operation and no significant inter-group difference existed in biliary/vascular complications.In higher group,4 patients showed graft dysfunctions during perioperative period.Two of them were discharged successfully after secondary transplantation and another 2 patients died.Conclusions On the premise of comprehensive evaluations of donor liver status and reasonable matching of recipients,aged marginal donor liver can be safely applied with excellent clinical outcomes.Severe fatty donor liver should be employed with caution.Hypertensive drugs,high serum sodium and long period of cold ischemia are also important influencing factors for aged donors.
作者
马震宇
陈拓
张全保
陶一峰
王正昕
Ma Zhenyu;Chen Tuo;Zhang Quanbao;Tao Yifeng;Wang Zhengxin(Department of General Surgery,Affiliated Huashan Hospital,Fudan University,Shanghai 200040,China)
出处
《中华器官移植杂志》
CAS
北大核心
2019年第10期595-600,共6页
Chinese Journal of Organ Transplantation
基金
国家科技重大专项(2017ZX10203205-003-003、2017ZX10203205-002-004)
国家自然科学基金项目(81873874)。
关键词
肝移植
脂肪肝
年龄因素
Liver transplantation
Fatty liver
Age factors
作者简介
通信作者:王正昕,Email:wangzhengxin@huashan.org.cn。
