Caralt M, Bello I, Sandiumenge A, Dopazo C, Pando E, Molino J A, Lázaro J L, Bilbao I, Pont T, Solé J, Charco R
HBP Surgery and Transplant Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Thoracic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Transplant Proc. 2019 Jan-Feb;51(1):9-11. doi: 10.1016/j.transproceed.2018.02.216. Epub 2019 Jan 14.
The number of organs retrieved from donation after circulatory death (DCD) donors has continued to rise in recent years. The functional superiority of DCD organs is achieved when the lungs are perfused with cold perfusion and livers with normothermic regional perfusion (NRP). Thus, a precise surgical technique is required to combine thoracic and abdominal organ procurement. The technique used at our center consists of a rapid laparotomy and middle sternotomy, then the abdominal aorta (Ao) and abdominal inferior vena cava (VC) are cannulated and the descending thoracic Ao is cross-clamped. NRP is started at that point. As a variation of previously described techniques, the thoracic vena cava is not initially clamped in order to improve the return of blood volume to the NRP circuit. The pulmonary artery is cannulated to flush the lungs and the left atrial appendage is opened for drainage. After 120 minutes, NRP perfusion is stopped and the organs are flushed with cold preservation solution. In 2016, 3 livers and 6 lungs were harvested at our center using the technique described. After a minimum follow-up of 1 year, no evidence of biliary complications was observed. The combined procurement of lungs after room temperature perfusion and liver after NRP without initial clamping of the thoracic VC is feasible, with excellent function post-transplantation.
近年来，从心脏死亡后器官捐献（DCD）供体获取的器官数量持续增加。当肺采用冷灌注、肝采用常温区域灌注（NRP）时，DCD器官的功能优势得以实现。因此，需要精确的手术技术来联合获取胸腹部器官。我们中心采用的技术包括快速剖腹术和胸骨正中切开术，然后分别插管至腹主动脉（Ao）和下腔静脉（VC），并阻断胸降主动脉。此时开始进行NRP。作为先前所述技术的一种改进，最初不阻断胸段腔静脉，以改善血液回流入NRP回路。经肺动脉插管冲洗肺脏，并打开左心耳进行引流。120分钟后，停止NRP灌注，并用冷保存液冲洗器官。2016年，我们中心采用所述技术获取了3例肝脏和6例肺脏。经过至少1年的随访，未观察到胆系并发症的迹象。在不预先阻断胸段腔静脉的情况下，先进行常温灌注获取肺脏、再进行NRP获取肝脏的联合器官获取技术是可行的，移植后器官功能良好。
