Controlled non-heart-beating donor liver transplantation: a successful single center experience, with topic update.

摘要: BACKGROUND The critical shortage of transplantable organs necessitates utilization unconventional donors. We describe a successful experience controlled non-heart-beating donor (NHBD) liver transplantation. METHODS Controlled NHBDs had catastrophic head injury, prognosis for no meaningful recovery, decision to withdraw life support, and subsequent consent donation. After stopping mechanical ventilation in the operating room, death determination by nontransplant caregiver, rapid aortic cannulation, kidneys were recovered. RESULTS contributed 5% hepatic allografts (8/164) from August 1996 through June 1999 (9% 1998). Sixteen afforded 8 livers 24 kidneys. Liver donors (n=8) 11-66 years old; half >50 old. Premortem alanine aminotransferase was 25-157 U/L. Arrest occurred 3-27 min after ventilation. Perfusion started 3-5 incision, <22 hypotension (mean arterial pressure: <50 mmHg). Patient graft survivals are 100% at 18+/-12 months follow-up. There intraoperative complication, reperfusion syndrome, poor function, primary nonfunction, thrombosis, biliary or serious infection. Postoperative day 2 prothrombin time 13+/-1 sec. Peak 980+/-601 Intensive care unit posttransplant lengths stay 2+/-2 10+/-7 days, respectively. Soon transplantation there frequent temporary hyperbilirubinemia (five eight recipients; bilirubin peak: 7-29 mg/dl, 2-3 weeks transplantation) rejection (4/8 recipients, <3 transplantation). CONCLUSIONS significantly safely expanded our pool. NHBD surgeons must be capable procurement. Cautious liberalization criteria accepting with confounding risk factors is justified. Refined ethics guidelines would broaden approval NHBDs.