Reich D J, Munoz S J, Rothstein K D, Nathan H M, Edwards J M, Hasz R D, Manzarbeitia C Y
Department of Surgery, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA.
Transplantation. 2000 Oct 27;70(8):1159-66. doi: 10.1097/00007890-200010270-00006.
The critical shortage of transplantable organs necessitates utilization of unconventional donors. We describe a successful experience of controlled non-heart-beating donor (NHBD) liver transplantation.
Controlled NHBDs had catastrophic head injury, prognosis for no meaningful recovery, decision to withdraw life support, and subsequent consent for donation. After stopping mechanical ventilation in the operating room, death determination by a nontransplant caregiver, and rapid aortic cannulation, liver and kidneys were recovered.
Controlled NHBDs contributed 5% of hepatic allografts (8/164) from August 1996 through June 1999 (9% in 1998). Sixteen NHBDs afforded 8 livers and 24 kidneys. Liver donors (n=8) were 11-66 years old; half were >50 years old. Premortem alanine aminotransferase was 25-157 U/L. Arrest occurred 3-27 min after stopping ventilation. Perfusion started 3-5 min after incision, and <22 min after hypotension (mean arterial pressure: <50 mmHg). Patient and graft survivals are 100% at 18+/-12 months follow-up. There was no intraoperative complication, reperfusion syndrome, poor graft function, primary nonfunction, arterial thrombosis, biliary complication, or serious infection. Postoperative day 2 prothrombin time was 13+/-1 sec. Peak alanine aminotransferase was 980+/-601 U/L. Intensive care unit and posttransplant lengths of stay were 2+/-2 and 10+/-7 days, respectively. Soon after transplantation there was frequent temporary hyperbilirubinemia (five of eight recipients; bilirubin peak: 7-29 mg/dl, 2-3 weeks after transplantation) and rejection (4/8 recipients, <3 weeks after transplantation).
NHBDs significantly and safely expanded our donor pool. NHBD surgeons must be capable of rapid procurement. Cautious liberalization of criteria for accepting livers from NHBDs with confounding risk factors is justified. Refined ethics guidelines would broaden approval of NHBDs.
可移植器官的严重短缺使得非常规供体的利用成为必要。我们描述了一例控制性非心脏跳动供体（NHBD）肝移植的成功经验。
控制性NHBDs有严重的头部损伤，无有意义恢复的预后，决定撤除生命支持，并随后同意捐赠。在手术室停止机械通气后，由非移植护理人员确定死亡，并迅速进行主动脉插管，然后获取肝脏和肾脏。
从1996年8月至1999年6月，控制性NHBDs提供了5%的肝移植供体（8/164）（1998年为9%）。16例NHBDs提供了8个肝脏和24个肾脏。肝脏供体（n = 8）年龄在11 - 66岁之间；一半年龄大于50岁。术前丙氨酸转氨酶为25 - 157 U/L。停止通气后3 - 27分钟发生心跳骤停。切开后3 - 5分钟开始灌注，低血压（平均动脉压：<50 mmHg）后<22分钟开始灌注。在18±12个月的随访中，患者和移植物存活率均为100%。无术中并发症、再灌注综合征、移植物功能不良、原发性无功能、动脉血栓形成、胆道并发症或严重感染。术后第2天凝血酶原时间为13±1秒。丙氨酸转氨酶峰值为980±601 U/L。重症监护病房和移植后的住院时间分别为2±2天和10±7天。移植后不久，常有短暂性高胆红素血症（8例受者中的5例；胆红素峰值：7 - 29 mg/dl，移植后2 - 3周）和排斥反应（4/8例受者，移植后<3周）。
NHBDs显著且安全地扩大了我们的供体库。NHBD外科医生必须具备快速获取器官的能力。谨慎放宽接受有混杂风险因素的NHBDs肝脏的标准是合理的。完善的伦理准则将扩大对NHBDs的认可。
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