Clinical effect analysis of 15 cases of liver transplantation from organ donation after citizen death: video attached

Abstract

Objective To investigate the clinical effect and experience of liver transplantation from organ donation after citizen death. Methods The clinical data of fifteen donors and recipients who received liver transplantation were retrospectively analyzed from February 2015 to November 2017 in the First Affiliated Hospital of Anhui Medical University. The perioperative condition and prognosis of liver transplant recipients were observed and analyzed. Results The 15 cases of organ donors belonged to the donation after brain and cardiac death (C-Ⅲ). Using the classical orthotopic liver transplantation in 7 cases and 8 cases of modified piggyback liver transplantation, operation was successfully completed. The quality of donor liver was 544.2-1 422.4 (1 171.9±289.6) g, the warm ischemia time was 9-22 (17.1±3.1) min,the cold ischemia time was 2-9 (5.4±2.0) h, the anhepatic phase was 43-100 (67.5±14.1) min, the amount of intraoperative bleeding was 300-3 000 (1 283.3 ±808.4) ml, the operation time was 355-605 (513.3±70.6) min, the postoperative respiratory support time was 5-960 (93.1±241.7) h, ICU stay time was 48-720 (126±167.9) h, postoperative hospitalization time was 13-103 (34.2±22.1) d, and the total hospitalization cost of 87.3-547.8 thousand yuan. The postoperative complications included delayed biliary anastomotic stenosis in 1 case, 1 case of upper gastrointestinal bleeding, small liver syndrome, multi-drug resistant bacteria infection, hepatic hydrothorax, 3 cases of acute rejection, 2 of pulmonary infection, 2 of herpes zoster virus infection, 1 of abdominal bleeding, 1 of hepatic subcapsular hematoma, 1 of liver transplantation of new tumors, 1 of bile leakage after removal of T tube and 1 case of bile leakage and diffuse peritonitis caused by T tube were removed. Postoperative follow-up time was 0.5-51 months. One case died of multiple organ failure 27 days after operation because of acute rejection and infection after operation, 1 case in 174 days after discharge because of the function of the transplanted liver failure with heart failure death, while more than 13 recipients of liver function recovered smoothly, and the prognosis is good. Conclusions Liver transplantation from donation after citizen death is still of high risks and complications. As with continuous optimization of organ donation procedures, strengthening the function of organ donation recipients maintenance, strictly grasping the surgical indications, perioperative management and regular follow-up, citizens of organ donation after death of donor liver can obtain good clinical curative effect. Key words: Liver transplantation; Tissue and organ harvesting; Organ donation after citizen death