摘要：目的探讨大鼠心脏停搏供体肝移植中，如何合理地选择供肝，以提高此类供体肝移植术后的存活率。方法实验分为3组，在供肝获取前分别经历供体心脏停搏(NHBD)15、30或45min(NHBD-15、NHBD-30和NHBD-45组)，而后各行18对大鼠原位肝移植。依据开腹时和冷灌洗后的表现将供肝分为Ⅰ、Ⅱ、Ⅲ级，并于冷灌洗后固定取供肝尾叶作病理观察。结果NHBD-15、NHBD-30和NHBD-45组的肝移植大鼠术后1周存活率分别为61.1％(11/18)、44．4％(8／18)和11.1％(2／18)，其中Ⅰ、Ⅱ级供肝合计的1周存活率分别为78.6％(11／14)、66.7％(8/12)和28.6％(2／7)，而各组Ⅲ级供肝肝移植大鼠均无存活超过48小时。结论植入前合理地选择心脏停搏供体的供肝，有助于提高此类供体肝移植的存活率。

The preliminary study of donor liver selection in liver transplantation from non-heart-beating donors

YAN Jiqi ,CAI Weiyao ,ZHANG Mingjun,et al.

(Department of Surgery,Ruijin Hospital,Shanghai Second Medical University,Shanghai 200025)

Abstract：Objective To investigate the way to raise the survival rate of rat liver transplantation from cardiac arrest rat donors (CAS) by selecting hepatic allografts rationally.Methods Rat liver transplantation was performed in 3 groups (NHBD-15,NHBD-30,NHBD-45) with 18 pairs in each,and the donor livers suffered 15,30 or 45 minutes from warm-ischemia in-duced by cardiac arrest before being harvested respectively.Donor rat liver was categorized into grade Ⅰ、Ⅱ and Ⅲ according to its appearance at the time of opening the abdomen and after perfusion.Liver biopsy was taken from the caudate lobe after cold flushing.Results One week survival rates in Group NHBD-15,Group NHBD-30 and Group NHBD-45 were 61.1% (11/18),44.4 % (8/18) and 11.1% (2/18) respectively.While the donor livers of grade Ⅰ and Ⅱ were taken into account,the suvival rates were 78.6% (11/14),66.7% (8/12) and 28.6% (2/7) respectively.None of the recipient rats survived more than 48 hours in those received the donor liver of grade Ⅲ.Conclusion Rational selection of hepatic allograft procured from cardiac arrest donors before implantation would be conducive to raising the survival rate of liver transplantation.

Keywords：Non-heart-beating donors;Liver transplantation;Donor liver;Selection

参考文献：

［1］Kamada N,Calne RY.A surgical experience with five hundred thirty liver transplantation in the rat.Surgery,1983,93:64-69.

［2］Casavilla A,Ramirez C,Shapiro R,et al.Liver and kidney trans-plantation from NHBD-heart beating donors:the Pittsburgh experi-ence.Transplant Proc,1995,27:710-712.

［3］严佶祺,李宏为,蔡伟耀.心脏停搏供体与肝移植.国外医学创伤与外科基本问题分册,1999,20:21-23.

［4］Casavilla A,Ramirez C,Shapiro R,et al.Experience with liver and kidney allografts from NHBD-heart-beating donors.Transplantation,1995,59:197-203.

［5］Schemmer P,Schoonhoven R,Swenberg JA,et al.Gentle in situ liv-er manipulation during organ harvest decreases survival after rat liver transplantation.Transplantation,1998,65:1015-1020.

［6］Tokunaga Y,Ozaki N,Wakashiro S,et al.Effects of perfusion pres-sure during flushing on the viability of the procured liver using nonin-vasive fluorometry.Transplantation,1988,45:1031-1035.

［7］Soejima Y,Yanaga K,Nisizaki T,et al.Effect of thromboxane syn-thetase inhibitor on NHBD-heart-beating donors in rat orthotopic liver transplantation.Surgery,1998,123:67-72.

［8］Sumimoto K,Inagaki K,Ito H,et al.Ischemia damage prevention by coenzyme Q10 treatment of donor before orthotopic liver transplan-tation:biochemical and histologic findings.Surgery,1987,102:821-827.

［9］Ikeda T,Yanaga K,Kishikawa K,et al.Ischemia injury in liver transplantation:difference in injury sites between warm and cold is-chemia in rats.Hepatology,1992,16:454-461.

［10］Xu HS,Jones RS.Study of rat liver transplantation from NHBD-heart-beating cadaver donor.J Am Coil Surg,1995,181:322-326.

收稿日期：1999-08-01