Kawaguchi A T, Gandjbahch I, Pavie A, Muneretto C, Solis E, Leger P, Bors V, Szefner J, Vaissier E, Levasseur J P
Department of Thoracic and Cardiovascular Surgery, Hôpital de la Pitié, Paris, France.
J Heart Transplant. 1990 Nov-Dec;9(6):631-7.
Changes in liver and kidney function were reviewed in 32 patients who received a Jarvik-7 total artificial heart (TAH) as a bridge to transplantation. Preoperatively, seven (22%) had significant isolated kidney dysfunction, five (15%) had isolated liver impairment, and 13 (41%) had combined disorder, affecting 25 (78%) of the 32 recipients. Immediately after TAH implantation, vigorous diuresis occurred, and biochemical indices improved in 17 patients: 71% of isolated kidney, 60% of isolated liver, and 38% of combined organ disorder were reversed irrespective of severity in preoperative dysfunction. In contrast, urine output remained poor, and biochemical indices continued to deteriorate in 15 patients regardless of preoperative status; as a result, kidney (28%), liver (17%), and combined organ failure (33%) accounted for a total of 78% of failure in this series. Although preoperative liver and kidney dysfunction were frequent and severe, they did not correlate with postoperative functional recovery and later transplantation. Recipient body size and initial postoperative urine output were found to be the variables discriminating patients with or without subsequent transplantation. Because liver/kidney failure remained as the leading cause of death, knowledge of the underlying cause of the organ failure would increase the success of TAH as a bridge to transplantation.
对32例接受贾维克-7型全人工心脏（TAH）作为移植过渡手段的患者的肝肾功能变化进行了回顾。术前，7例（22%）有明显的孤立性肾功能障碍，5例（15%）有孤立性肝功能损害，13例（41%）有合并症，累及32例受者中的25例（78%）。TAH植入后立即出现强力利尿，17例患者的生化指标得到改善：孤立性肾功能障碍患者中有71%、孤立性肝功能损害患者中有60%、合并器官功能障碍患者中有38%的指标得到逆转，且与术前功能障碍的严重程度无关。相比之下，15例患者的尿量仍然很少，生化指标持续恶化，与术前状态无关；结果，本系列中肾脏（28%）、肝脏（17%）和合并器官功能衰竭（33%）占总衰竭病例的78%。虽然术前肝肾功能障碍常见且严重，但它们与术后功能恢复及后期移植并无关联。发现受者体型和术后初始尿量是区分有无后续移植患者的变量。由于肝/肾功能衰竭仍然是主要死因，了解器官衰竭的潜在原因将提高TAH作为移植过渡手段的成功率。
