摘要目的 总结心脏死亡器官捐献(donation after cardiac death,DCD)供体供肝获取及应用于肝移植的单中心临床经验.方法 回顾性分析2012年1月至2017年9月单中心115例DCD供者和受者的临床资料,分析患者术中、术后及预后情况.随访时间截至2017年10月30日.正态分布的计量资料的统计采用t检验,计数资料采用x2检验或Fisher确切概率法检验,累计生存率采用Kaplan-Meier法计算.结果 115例供体均符合中国标准Ⅲ类(即脑-心双死亡标准器官捐献,donation after brain death plus cardiac death,DBCD).供肝的热缺血时间为3～ 28 min,平均为(10±4) min;冷缺血时间为2.5～14.0 h,平均为(6.1±1.7)h.115例受者均顺利完成肝移植手术.受体术前MELD评分6～31分,平均(14±7)分.115例肝移植中ABO血型不相容肝移植7例(A→O,3例,B→O2例,AB→O1例,AB→A1例),其余供受体血型均符合输血原则.术后30 d内发生并发症(Clavien-Dindo分级Ⅲ～Ⅴ级)19例,发生率为16.5％,围手术期死亡率为2.6％ (3/115).出院患者均接受随访,平均随访时间为(21 ±17)个月.总体术后1、3、5年受者累计生存率分别为93.6％、81.8％、77.5％. 结论 经过严格筛选的DCD供肝肝移植是安全可行的,是目前我国解决移植器官短缺的良好方式.

abstractsObjective To investigate the clinical outcomes of liver transplantation by using donation after cardiac death (DCD) in single center.Methods The clinical data of 115 DCD donors and recipients of liver transplantation from Jan 2012 to Sep 2017 at our institution were analyzed,including preoperative general data,intraoperative status,and postoperative early complications.Patients were followed up to Oct 30th,2017.The measurement data with normal distribution were analyzed by t test,the enumeration data were analyzed by chi-square test or Fisher exact probability test,and the Kaplan-Meier method was used for survival analysis.Results All of the 115 donors were within China category Ⅲ using the classification of China donor after cardiac death.Donor graft mean warm ischemic time and cold ischemic time was (10 ± 4) min and (6.1 ± 1.7) h,respectively.All of the recipients underwent liver transplantation successfully.The mean preoperation MELD score was 14 ± 7.Seven patients were ABO-incompatible liver transplantation (A→O,3 cases,B→O 2 cases,AB→O 1 case,AB→A 1 case).19 patients (16.5％) had postoperative complications (Clavien-Dindo classification grade Ⅲ-Ⅴ).The perioperative mortality was 2.6％ (3 cases).All patients were followed up for an average (21 ± 17) mon.Patients 1-,3-,and 5-year survival rates were 93.6％,81.8％,and 77.5％,respectively.Conclusion The outcome of DCD liver transplantation is favorable at our institution under careful donor and recipient selection and intensive perioperative management.