Tenderich G, Koerner M M, Posival H, Arusoglu L, Hornik L, Mirow N, Stuettgen B, Wlost S, Minami K, Koerfer R
Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany.
Transplantation. 1998 Nov 15;66(9):1163-7. doi: 10.1097/00007890-199811150-00009.
The current shortage of donor organs, combined with an increasing demand for cardiac allografts, means that extended donor criteria are becoming more and more accepted. The use of cardiac allografts for transplantation from donors after acute poisoning is still under discussion; few data are currently available in the medical literature. We describe our experience with 19 orthotopic heart transplant recipients of organs from donors after acute intoxication with different agents.
Between March 1989 and December 1997, 883 orthotopic heart transplantations were performed at our transplant unit. Within this group, we accepted donor hearts after ethanol intoxication (n=1), benzodiazepine (n=1), alkylphosphate (E 605) in combination with beta-blocker intoxication (n=1), carbon monoxide poisoning (n=5), digitalis (n=1), digitalis/glibenclamide (n=1), chlormethiazole (n=1), propoxyphene (n=1), alkylphosphate (E 605) (n=1), insulin (n=2), neprobamate/ thiocyacide/flurazepam (n=1), paracetamol (n=1), carbamazepine (n=1), and cyanide (n=1) intoxication. At the time of organ explantation, hemodynamic data were available from all patients.
Early mortality in this group was 11%; cumulative survival after 5 years was 74%.
Based on our limited experience, cardiac allografts from donors exposed to different kinds of poisons can be transplanted in selected cases. If the donor organ is not hemodynamically compromised, showing regular filling pressures on low or mild inotropic support just before explantation, and if there are no electrocardiographic changes in combination with elevation of the transaminases, cardiac allograft transplantation seems to be a safe and life-saving procedure.
目前供体器官短缺，加上心脏移植需求不断增加，这意味着扩大供体标准越来越被接受。急性中毒后供体心脏用于移植仍在讨论中；医学文献中目前可用的数据很少。我们描述了19例原位心脏移植受者接受不同药物急性中毒后供体器官的经验。
1989年3月至1997年12月，我们的移植单位进行了883例原位心脏移植。在该组中，我们接受了乙醇中毒后（n = 1）、苯二氮䓬（n = 1）、烷基磷酸酯（E605）与β受体阻滞剂中毒联合（n = 1）、一氧化碳中毒（n = 5）、洋地黄（n = 1）、洋地黄/格列本脲（n = 1）、氯美噻唑（n = 1）、丙氧芬（n = 1）、烷基磷酸酯（E605）（n = 1）、胰岛素（n = 2）、眠尔通/硫氰酸盐/氟西泮（n = 1）、对乙酰氨基酚（n = 1）、卡马西平（n = 1）和氰化物（n = 1）中毒后的供体心脏。在器官切取时，所有患者均有血流动力学数据。
该组早期死亡率为11%；5年后累积生存率为74%。
基于我们有限的经验，在某些特定情况下，接触不同毒物的供体心脏可以进行移植。如果供体器官在血流动力学上没有受损，在切取前在低或轻度正性肌力支持下显示正常充盈压，并且如果没有心电图改变合并转氨酶升高，心脏移植似乎是一种安全且挽救生命的手术。
