Liver transplantation from donation after cardiac death donors / 中华消化外科杂志

ABSTRACT

Objective To summarize the clinical experiences in liver transplantation from donation after cardiac death donors. Methods The clinical data of 20 recipients who underwent liver transplantation from donation after cardiac death of 20 donors at the Guangzhou General Hospital of Guangzhou Military Area from July 2006 to May 2011 were retrospectively analyzed.Extracorporeal membrane oxygenation (ECMO) was applied to donors with brain and cardiac death to avoid warm ischemia.Donors in type Ⅲ according to the Maastricht classification did not receive ECMO.Liver grafts were obtained 5 minutes after the stop of heartbeat of the donors.Orthotopic liver transplantation was performed on recipients.Seventeen recipients received end-to-end bile duct anastomosis and 3 received cholangioenterostomy.All the recipients were followed up regularly.The survival curve was drawn by Kaplan-Meier method.Results Of the 20 donors,2 ( 10％ ) were in the type of Maastricht Ⅲ and 18 (90％) were donation after brain and cardiac death donors.Liver transplantation was successfully performed on all recipients,and the mean operation time,duration of anhepatic phase,mean volume of blood loss and duration of postoperative intensive care unit stay were (6.2 ± 2.7 ) hours,( 54 ± 13 ) minutes,( 2305 ± 1311 ) ml and (44 ±35) hours,respectively.There was no mortality during operation,and no recovering delay and non-function of the transplanted liver occurred.One recipient died of sepsis and 1 died of pulmonary infection at 1 month after operation,the other 18 recipients all survived.The longest survival time was 58 months.Conclusions Donation after cardiac death is the main source of liver grafts in China currently,and donation after brain and cardiac death is the main type.Establishment of rational flow-sheets of the donation after cardiac death and liver transplantation,rational application of ECMO for protecting the liver grafts are helpful for the work of organ donation after brain and cardiac death.