Abstract:

Objective To invenstigate the clinical situation of donation after citizen's death（DCD）donor liver in adult recipients and to analyze the hemodynamic changes after transplantation. Methods Three successful DCD donor child-to-adult liver transplantations have reviewed since 2014 in Shanxi Provincial People's hospotal. All the three donors were male，with an average age of 7 years. All of them suffered with brain benign tumor. All recipients were female，they suffered from liver cirrhosis after hepatitis C or B. Ratio of donor liver volume to recipient standard liver volume（GV/SLV）were separately 45%，60% and 62%. Ratio of donor liver weight to recipient weight（GRWR） were separately 1%，1.4% and 1.4%. The patient accepted the orthotopic liver transplantation. Intraoperative ligation of spleen artery was done and T tube was placed into bile duct. Postoperative range of alanine aminotransferase（ALT）， bile flow，total bilirubin（TBiL）were observed，and color Doppler ultrasound monitored portal vein and hepatic arterial blood flow. After one year of follow-up visit，the recipient recovered smoothly. Results The change of ALT was stable after operation，and 1 weeks after operation，the patients recovered to normal. TBiL rised rapidly in the postoperative，reached the peak after 24 h，and decreased significantly after 72 h. After 72 h，bile fiow increased significantly. After the first day of the portal vein flow reached the peak，then the flow gradually slowed，and the tend was stable. The trend of the changes of hepatic artery resistance index was similar to that of vein. Conclusion DCD child-to-adult liver transplantation should only be used for comparatively matched donor and recipient. It is safe aneffective and alleviate the problem of insufficient donor liver. In order to prevent SFSS and biliary stricture，partial ligation of splenic artery and placement of T tube should be done.