López-Navidad A, Caballero F, González-Segura C, Cabrer C, Frutos M A
Department of Organ & Tissue Procurement for Transplantation, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Spain.
Clin Transplant. 2002 Jun;16(3):151-62. doi: 10.1034/j.1399-0012.2002.01109.x.
The shortage of organs for transplantation has made it necessary to extend the criteria for the selection of donors, among others including those patients who die because of toxic substances such as methanol. Methanol is a toxic which is distributed through all the systems and viscera of the organism and tends to cause a severe metabolic acidosis. It can specifically cause serious or irreversible lesions of the central nervous system (CNS) and retina, and ultimately brain death. We present our experience with 16 organ donors who died as a result of acute methanol intoxication in 10 Spanish hospitals over the last 14 yr.
Between October 1985 and July 1999, 16 organ donors with brain death caused by acute methanol intoxication, 13 females and three males with a mean age of 38.4 +/- 7.6 yr (interval: 26-55 yr), allowed 37 elective transplants to be performed: 29 kidneys, four hearts and four livers for 37 recipients, and one urgent liver transplantation to a recipient with fulminant hepatitis.
The immediate postoperative period was favourable for the 38 graft recipients. None of the graft recipients presented gap anion metabolic acidosis in the immediate postoperative period, nor symptomatology or lesions of the CNS characteristic of methanol intoxication. Two patients died during the first month post-transplantation, a liver recipient and a heart recipient, at 16 and 24 days, respectively, because of acute rejection of the graft. At 1 month after transplantation 35 of the 36 recipients had been discharged from hospital with normal-functioning grafts. The last of the recipients, a kidney recipient, was discharged at 6 wk with normal-functioning graft. Actuarial survival of the graft and patient of kidney recipients at 1, 3 and 5 yr was 92.6, 77.8, and 75%, and 100, 88.9 and 83.3%, respectively; with average serum creatinines of 139.9 +/- 42.9, 150.4 +/- 42.8, and 164.4 +/- 82.5 micromol/L, respectively. At 1 yr after transplantation the three heart recipients and two of the three liver recipients had normal-functioning graft.
Methanol intoxication is not transferred from the donor to the recipient. The survival of the graft and kidney, heart and liver recipients using organs from donors who die because of methanol does not differ in the short- and long-term from the transplants performed with organs from donors who die from other causes.
移植器官的短缺使得有必要扩大供体选择标准，其中包括那些因甲醇等有毒物质致死的患者。甲醇是一种毒素，可遍布机体的所有系统和内脏，往往会导致严重的代谢性酸中毒。它可特异性地引起中枢神经系统（CNS）和视网膜的严重或不可逆损伤，最终导致脑死亡。我们介绍了过去14年中在10家西班牙医院因急性甲醇中毒死亡的16例器官供体的经验。
1985年10月至1999年7月，16例因急性甲醇中毒导致脑死亡的器官供体，其中13例女性，3例男性，平均年龄38.4±7.6岁（范围：26 - 55岁），共进行了37例择期移植手术：为37例受者移植了29个肾脏、4颗心脏和4个肝脏，还为1例暴发性肝炎受者进行了1例紧急肝移植。
38例移植受者术后早期情况良好。所有移植受者术后早期均未出现阴离子间隙代谢性酸中毒，也没有甲醇中毒特有的中枢神经系统症状或损伤。2例患者在移植后第一个月内死亡，1例肝移植受者和1例心脏移植受者分别于术后16天和24天因移植器官急性排斥反应死亡。移植后1个月时，36例受者中的35例已出院，移植器官功能正常。最后1例受者为肾移植受者，术后6周出院，移植肾功能正常。肾移植受者的移植器官和患者在1年、3年和5年的精算生存率分别为92.6%、77.8%和75%，以及100%、88.9%和83.3%；平均血清肌酐分别为139.9±42.9、150.4±42.8和164.4±82.5μmol/L。移植后1年时，3例心脏移植受者中的3例以及3例肝移植受者中的2例移植器官功能正常。
甲醇中毒不会从供体转移至受体。使用因甲醇死亡供体的器官进行移植的肾、心、肝移植受者及移植器官的短期和长期生存率与使用因其他原因死亡供体器官进行的移植并无差异。
