[1]蒋华驰,陈 员,陈静瑜.心脏死亡供肺肺移植临床分析[J].南京师范大学学报(自然科学版),2017,40(02):92.[doi:10.3969/j.issn.1001-4616.2017.02.016]
　Jiang Huachi,Chen Yuan,Chen Jingyu.Clinical Analysis of Lung Transplantation from Donor of Cardiac Death[J].Journal of Nanjing Normal University(Natural Science Edition),2017,40(02):92.[doi:10.3969/j.issn.1001-4616.2017.02.016]
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心脏死亡供肺肺移植临床分析()
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《南京师范大学学报》（自然科学版）[ISSN:1001-4616/CN:32-1239/N]

卷:
第40卷
期数:
2017年02期
页码:
92
栏目:
·生命科学·
出版日期:
2017-06-29

文章信息/Info

Title:
Clinical Analysis of Lung Transplantation from Donor of Cardiac Death
文章编号:
1001-4616(2017)02-0092-06
作者:
蒋华驰; 陈 员; 陈静瑜
南京医科大学附属无锡市人民医院胸外科,江苏 无锡 214023
Author(s):
Jiang Huachi; Chen Yuan; Chen Jingyu
Department of General Thoracic Surgery,Wuxi People’s Hospital,Nanjing Medical University,Wuxi 214023,China
关键词:
心脏死亡; 供肺管理; 肺移植
Keywords:
cardiac death; donor management; lung transplantation
分类号:
R655
DOI:
10.3969/j.issn.1001-4616.2017.02.016
文献标志码:
A
摘要:
探讨心脏死亡供体(DCD)肺移植围手术期供肺保护策略对肺移植术后的疗效. 回顾性分析2015年1月至2015年12月无锡市人民医院肺移植中心完成的21例DCD供肺移植的临床资料,受者原发病种包括肺间质纤维化9例,慢性阻塞性肺疾病4例,支气管扩张4例,硅肺2例,肺结核毁损肺1例,特发性肺动脉高压1例. 总结分析供肺术前维护策略及受者术后早期死亡原因. 21例受者手术过程顺利,术后5例受者早期死亡(<30 d),原因包括2例肺部感染,1例原发性移植物功能丧失(PGD),1例急性排斥反应(AR),1例肺栓塞. 受者术后肺功能较术前显著改善,术后1年存活率76.1%. 心脏死亡供肺经有效维护供肺可扩展供肺数量.
Abstract:
To investigate the outcome of lung management for donors after cardiac death(DCD)during preoperative period. 21 lung transplantations from DCD donors were performed in Wuxi People’s Hospital from January 2015 to November 2015. In which there were 9 pulmonary fibrosis,4 chronic obstructive pulmonary disease,4 bronchiectasis,2 silicosis,1 pulmonary tuberculosis,1 idiopathic pulmonary arterial hypertension. We retrospectively summarized the donor protective strategies and analyzed the causes of early death of recipients. 21 lung transplants were performed successfully. In-hospital mortality(<30 d)was 5/21. Death after transplantation was due to infection(n=2),primary lung graft dysfunction function(n=1),acute rejection(n=1),pulmonary vein embolism(n=1). The 1-year survival rate after lung transplants was 76.1% and the pulmonary function was improved significantly. The application of effective management in donors of cardiac could be used to significantly increase the donor pool.

参考文献/References:

[1] 毛文君,陈静瑜,郑明峰,等. 棉子糖低钾右旋糖酐液在临床肺移植中的应用[J]. 中华器官移植杂志,2012,33(5):275-279.
[2]陈静瑜. 胸部微创技术在肺移植切口中的应用[J]. 中国微创外科杂志,2006,6(9):648-649.
[3]D’sALESSANDRO A M,HOFFMANN R M,KNECHTLE S J,et al. Controlled non-heart-beating donors:a potential source of extrarenal organs[J]. Transplant Proc,1995,27(1):707-709.
[4]STEEN S,SJOBERG T,PIERRE L,et al. Transplantation of lungs from a non-heart-beating donor[J]. Lancet,2001,357(9 259):825-829.
[5]CYPEL M,SATO M,YILDIRIM E,et al. Initial experience with lung donation after cardio circulatory death in Canada[J]. Journal of heart and lung transplantation,2009,28(8):753-758.
[6]DE OLIVEIRA N C,OSAKI S,MALONEY J D,et al. Lung transplantation with donation after cardiac death donors:long-term follow-up in a single center[J]. Journal of thoracic and cardiovascular surgery,2010,139(5):1 306-1 315.
[7]PURI V,SCAVUZZO M,GUTHRIE T,et al. Lung transplantation and donation after cardiac death:a single center experience[J]. Annals of thoracic surgery,2009,88(5):1 614-1 615.
[8]ERASMUS M E,VAN RAEMDONCK D,AKHTAR M Z,et al. DCD lung donation:donor criteria,procedural criteria,pulmonary graft function validation,and preservation[J]. Transplant international,2016,29(7):790-797.
[9]OTO T,LEVVEY B,MCEGAN R,et al. A practical approach to clinical lung transplantation from a Maastricht Category Ⅲ donor with cardiac death[J]. Journal of heart and lung transplantation the official publication of the international society for heart transplantation,2007,26(2):196-199.
[10]SNELL G I,LEVVEY B J,OTO T,et al. Early lung transplantation success utilizing controlled donation after cardiac death donors[J]. American journal of transplantation,2008,8(6):1 282-1 289.
[11]LOEHE F,MUELLER C,ANNECKE T,et al. Pulmonary graft function after long-term preservation of non-heart-beating donor lungs[J]. Annals thoracic surgery,2000,69(5):1 556-1 562.
[12]王振兴,陈静瑜,郑明峰,等. 肺移植供肺获取100例:冷缺血时间>6 h及肺减容对预后的影响[J]. 中国组织工程研究,2012,16(5):835-838.
[13]李欣,李辉,胡滨,等. 肺移植冷缺血时间与支气管吻合口狭窄的相关性研究[J]. 首都医科大学学报,2014,35(6):702-704.
[14]MASCIA L,PASERO D,SLUTSKY A S,et al. Effect of a lung protective strategy for organ donors on eligibility and availability of lungs for transplantation:a randomized controlled trial[J]. JAMA,2010,304(23):2620.
[15]张桂芬. 供体肺保存研究现状[J]. 中国民康医学,2015(9):86-88.
[16]MI?AMBRES E,BALLESTEROS M A,RODRIGO E,et al. Aggressive lung donor management increases graft procurement without increasing renal graft loss after transplantation[J]. Clinical transplant,2013,27(1):52-59.
[17]SABASHNIKOV A,PATIL N P,POPOV A F,et al. Long-term results after lung transplantation using organs from circulatory death donors:a propensity score-matched analysis[J]. European journal of cardio-thoracic surgery,2016,49(1):1-8.
[18]VENKATESWARAN R V,DRONAVALLI V,PATCHELL V,et al. Measurement of extra vascular lung water following human brain death; implications for lung donor assessment and transplantation[J]. European journal of cardio-thoracic surgery,2013,43(6):1 227-1 232.
[19]OTO T,EXCELL L,GRIFFITHS A P,et al. Association between primary graft dysfunction among lung,kidney and heart recipients from the same multiorgan donor[J]. American journal of transplantation,2008,8(10):2 132-2 139.
[20]ROSTRON A J,AVLONITIS V S,CORK D M,et al. Hemodynamic resuscitation with arginine vasopressin reduces lung injury after brain death in the trans-plant donor[J]. Transplantation,2008,85(85):597-606.
[21]OTO T,EXCELL L,GRIFFITHS A P,et al. The implications of pulmonary embolism in a multiorgan donor for subsequent pulmonary,renal,and cardiac transplantation[J]. Journal of heart and lung transplantation the official publication of the international society for heart transplantation,2008,27(1):78-85.
[22]OTO T,RABINOV M,GRIFFITHS A P,et al. Unexpected donor pulmonary embolism affects early outcomes after lung transplantation:a major mechanism of primary graft failure?[J]. Journal of thoracic cardiovascular surgery,2005,130(5):1 446.
[23]OKAZAKI M,DATE H,INOKAWA H,et al. Optimal time for post-mortem heparinization in canine lung transplantation with non-heart-beating donors[J]. Journal of heart and lung transplantation the official publication of the international society for heart transplantation,2006,25(4):454-460.
[24]ZYCH B,POPOV A F,AMRANI M,et al. Lungs from donation after circulatory death donors:an alternative source to brain-dead donors?Midterm results at a single institution[J]. European journal of cardio-thoracic surgery,2012,42(3):542.
[25]LEVVEY B J,HARKESS M,HOPKINS P,et al. Excellent clinical outcomes from a national donation after determination of cardiac death lung transplant collaborative[J]. American journal of transplantation official journal of the American society of transplantation and the American society of transplant surgeons,2012,12(9):2 406.
[26]MULLIGAN M S,SHEARON T H,WEILL D,et al. Heart and lung transplantation in the United States,1997-2006[J]. American journal of transplantation official journal of the American society of transplantation and the American society of transplant surgeons,2008,8(4p2):977-987.
[27]CYPEL M,YEUNG J C,MACHUCA T,et al. Experience with the first 50 ex vivo lung perfusions in clinical transplantation[J]. Journal thoracic and cardiovascular surgery,2012(144):1 200.
[28]王大鹏,陈静瑜,许红阳,等. 体外膜肺氧合联合连续肾脏替代疗法在肺移植术后严重原发性移植物失功治疗中的应用[J]. 中华移植杂志(电子版),2015(4):170-173.
[29]CHRISTIE J D,KOTLOFF R M,AHYA V N,et al. The effect of primary graft dysfunction on survival after lung transplantation[J]. American journal respiratory and critical care medicine,2005,171(11):1 312-1 316.
[30]HERTZ M I,MOHACSI P J,BOUCEK M M,et al. The registry of the international society for heart and lung transplantation:twenty-second official adult lung and heart-lung transplant report-2005[J]. Journal of heart and lung transplantation,2005,24(8):956-967.

备注/Memo

备注/Memo:
收稿日期:2016-11-12.
基金项目:南京医科大学科技发展基金面上项目(2015NJ-MU146).
通讯联系人:陈静瑜,主任医师,博士生导师,研究方向:肺移植. E-mail:chenjingyu333@sina.com
更新日期/Last Update: 2017-06-30