关键词:

肝移植 , 热缺血时间 , 心脏死亡后器官捐献

Abstract:

Objective Donation after circulatory death（DCD）is considered a way to alleviate organ shortage，which increases the mortality of patients waiting for organ transplantation. After the withdrawal of life-sustained therapy，a series of pathological changes in the donor organ may impact graft outcome. This study is to investigate the ischemic pathophysiology of donor's liver after circulatory death in porcine model. Methods Sixteen Bama minipigs（8 females，8 males，45 ~ 55 kg）were used in this study. A porcine DCD model was created by the asphyxia method. Hemodynamic changes after ventilation withdrawal were recorded，and pathological changes in the donor's liver during warm ischemia time（WIT）were assessed. Results The average survival duration was 17.94 min. Systolic and diastolic blood pressures increased in the first 5 minutes，then decreased continuouslyafterward. Central venous pressure increased in the first 10 minutes and then decreased continuously afterward. Simultaneously，PaO2 dropped sharply to 0 in the first 10 minutes，and PaCO2 gradually rose to a stable level of 100 mmHg（1 mmHg ＝ 0.133 kPa）. The histological assessment indicated that warm ischemic injury on livertissue aggravated gradually as time progressed. In subcellular observation，ischemic injury within 30 minutes of WITseemed to be reversible，but longer WIT caused irreversible degeneration. Conclusion Through the porcine ventilation withdrawal model，the circulatory death in the clinical setting could be simulated. Damage to graft tissues was positively correlated with WIT. 30 minute WIT after confirmation of circulatory death with the asphyxia method appeared to be a limit for a desirable organ quality. 

Key words:

Liver transplantation, Warm ischemia time, Donation after circulatory death