Duque E, Duque J, Nieves M, Mejía G, López B, Tintinago L
Department of Transplantation, Universidad de Antioquia, Medellín, Columbia.
Transplant Proc. 2007 Sep;39(7):2076-8. doi: 10.1016/j.transproceed.2007.06.072.
Laryngeal transplantation is a possibility for patients with irreversible laryngeal disease, such as complex trauma and larynx cancer. The objective of performing this procedure was to solve problems that these patients face with a laryngectomy. The medical literature has reviews about larynx transplantations, but almost nothing about the larynx donor. The following is our experience on management of these donors.
Selection criteria was as follows: (1) 18-50 years old; (2) gender and ABO blood type matched between donor and recipient; (3) No abuse of tobacco, cocaine, and marijuana, (4) tracheal intubation time <3 days; and (5) time in the intensive care unit <7 days. The preservation was simple hypothermia with larynx infusion via the carotid artery with University of Wisconsin solution.
Between 2001 and 2006, we managed 25 donors, among whom 12 grafts were discarded. The 13 larynx donors were of average age 27.2 +- 7.9 years and their cause of death was head trauma. Each was of male and 12 were multiorgan donors. Three donors had previous consumption of tobacco and 2 donors of marijuana. There were 2 cases of acute rejection episodes. Graft survival rate at 2 years was 90%.
These donors may have differences from other multiorgan donors: (1) they do not require strict fluid management; (2) vasoactive agents may be used in higher doses than in organ donors, and (3) the larynx tolerates hemodynamic instability. It was necessary to use some donors who had used addictive substances, showing that some selection criteria may be flexible. There was no conflict between thoracic surgeons and larynx surgeons. The priority always was for life-saving organs. Family consent was sometimes difficult because of the retrieval times and body donor reconstruction. The larynx surgery retrieval demanded an additional 2-5 hours during routine multiorgan donor surgery, and always the family asked about body reconstruction. The body appearance was always preserved.
对于患有不可逆喉疾病（如复杂创伤和喉癌）的患者，喉移植是一种可行的治疗方法。进行该手术的目的是解决这些患者因喉切除术而面临的问题。医学文献中有关于喉移植的综述，但关于喉供体的报道几乎没有。以下是我们在这些供体管理方面的经验。
选择标准如下：（1）年龄在18至50岁之间；（2）供体与受体性别及ABO血型匹配；（3）无烟草、可卡因和大麻滥用史；（4）气管插管时间<3天；（5）在重症监护病房的时间<7天。采用单纯低温保存，通过颈动脉用威斯康星大学溶液灌注喉。
2001年至2006年间，我们管理了25例供体，其中12例移植物被丢弃。13例喉供体的平均年龄为27.2±7.9岁，其死亡原因是头部创伤。均为男性，12例为多器官供体。3例供体曾有吸烟史，2例有大麻使用史。发生2例急性排斥反应。2年移植物存活率为90%。
这些供体可能与其他多器官供体存在差异：（1）他们不需要严格的液体管理；（2）血管活性药物的使用剂量可能高于器官供体；（3）喉能耐受血流动力学不稳定。有必要使用一些有药物成瘾史的供体，这表明某些选择标准可能具有灵活性。胸外科医生和喉外科医生之间没有冲突。首要考虑的始终是挽救生命的器官。由于获取时间和遗体供体重建问题，有时很难获得家属同意。在常规多器官供体手术中，喉手术获取需要额外2至5小时，而且家属总是询问遗体重建情况。遗体外观始终得到保留。
