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.

摘要：

目的 探讨儿童公民逝世后器官捐献（DCD）供肝应用于成人受者临床情况，对移植后引起 的血流动力学变化进行分析。方法 回顾性分析山西省人民医院 2014 年 7 月-2017 年 6 月完成的 3 例儿 童 DCD 供肝应用于成人的临床资料。3 例儿童供体均为男性，平均年龄为 9 岁。受体均为女性，为丙肝肝 硬化或乙肝肝硬化。供肝体积与受体标准肝体积比（GV/SLV）为 45%、60%、62%，供肝重量与受体体重 比（GRWR）分别为 1%、1.4%、1.4%。术式为经典原位肝移植，术中结扎脾动脉，胆道放置 T 管。术后检 测丙氨酸转氨酶（ALT）、胆汁引流量、总胆红素值（TBiL），彩超监测门静脉、肝动脉血流量，术后回访 患者恢复情况。结果 术后肝功能变化较平稳，约术后 1 周即恢复正常，门静脉流速术后第 1 天达到峰值， 之后流速逐渐变缓，趋于平稳，肝动脉阻力指数变化趋势与之类似。结论 儿童 DCD 供肝应用于条件相匹 配的成人受体是安全有效的，缓解了供肝不足问题，为预防术后剧烈血流动力学变化甚至小肝综合征（SFSS） 术中应结扎脾动脉。