Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
Am J Transplant. 2010 Mar;10(3):602-11. doi: 10.1111/j.1600-6143.2009.02965.x. Epub 2010 Jan 5.
The first liver transplantation (LTx) in Sweden was performed in 1984, but brain death as a legal death criterion was not accepted until 1988. Between November 1984 and May 1988, we performed 40 consecutive LTxs in 32 patients. Twenty-four grafts were from donors after cardiac death (DCD) and 16 grafts from heart-beating donors (HBD). Significantly, more hepatic artery thrombosis and biliary complications occurred in the DCD group (p < 0.01 and p < 0.05, respectively). Graft and patient survival did not differ between the groups. In the total group, there was a significant difference in graft survival between first-time LTx grafts and grafts used for retransplantation. There was better graft survival in nonmalignant than malignant patients, although this did not reach statistical significance. Multivariate analysis revealed cold ischemia time and post-LTx peak ALT to be independent predictive factors for graft survival in the DCD group. In the 11 livers surviving 20 years or more, follow-up biopsies were performed 18-20 years post-LTx (n = 10) and 6 years post-LTx (n = 1). Signs of chronic rejection were seen in three cases, with no difference between DCD and HBD. Our analysis with a 20-year follow-up suggests that controlled DCD liver grafts might be a feasible option to increase the donor pool.
瑞典于 1984 年完成首例肝移植（LTx），但脑死亡作为合法死亡标准直到 1988 年才被接受。1984 年 11 月至 1988 年 5 月期间，我们在 32 名患者中进行了 40 例连续的 LTx。24 个移植物来自心脏死亡后供体（DCD），16 个移植物来自心跳供体（HBD）。值得注意的是，DCD 组的肝动脉血栓形成和胆漏并发症明显更多（p<0.01 和 p<0.05）。两组间移植物和患者存活率无差异。在总组中，首次 LTx 移植物和再次移植的移植物的存活率存在显著差异。非恶性患者的移植物存活率优于恶性患者，尽管这并未达到统计学意义。多变量分析显示，冷缺血时间和移植后丙氨酸转氨酶峰值是 DCD 组移植物存活率的独立预测因素。在存活 20 年或以上的 11 个肝脏中，进行了 18-20 年（n=10）和 6 年（n=1）的 LTx 后随访活检。3 例出现慢性排斥反应迹象，DCD 和 HBD 之间无差异。我们的 20 年随访分析表明，控制 DCD 肝移植物可能是增加供体库的可行选择。
