Abstract: Objective:To investigate the clinical effect and complications of liver transplantation from Chinese donation after citizen′s death (CDCD).
Methods:The retrospective descriptive study was adopted. The clinical data of 289 recipients who received liver transplantation at the Zhongnan
Hospital of Wuhan University (189 recipients) and the 3rd Xiangya Hospital of Central South University (100 recipients) from June 2010 to June 2015 were collected. Fortytwo recipients from donation after brain death (DBD) donors, 77 from donation after cardiac death (DCD) donors and 170 from donation after brain death plus cardiac death (DBCD) donors were respectively allocated into the DBD group, DCD group and DBCD group. The modified piggyback liver transplantation was conducted. Observation indicators included (1) postoperative liver function of recipients, (2)postoperative complications, (3) 1 and 3year survival rates. The followup using outpatient examination and telephone interview was performed to detect the survival rate of patients once every week within postoperative month 3, once every 3 weeks for month 4-6, once every month for month 7-12 and once every 3 months after 1 year, with followup time more than 36 months up to May 2015. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were represented as M and analyzed by the nonparametric test. Count data were analyzed using chisquare test.
Results:(1) The level of alanine transaminase (ALT) of recipients from preoperation to postoperative day 14 was from 204 U/L to 154 U/L in the DBD group, from 190 U/L to 216 U/L in the DCD group and from 204 U/L to 153 U/L in the DBCD group, respectively, with a statistically significant difference in the changing trend of ALT among the 3 groups (χ²=7.280, P<0.05). The level of total bilirubin (TBil) of recipients from preoperation to postoperative day 14 was from 147 μmol/L to 43 μmol/L in the DBD group, from 95 μmol/L to 100 μmol/L in the DCD group and from 143 μmol/L to 37 μmol/L in the DBCD group, respectively, with no statistically significant difference (χ²=4.355, P>0.05). (2) The comparison of complications: the primary graft dysfunction, systemic inflammatory response syndrome and acute rejection were respectively detected in 1, 8, 4 recipients in the DBD group, 3, 31, 19 in the DCD group and 6, 29, 45 recipients in the DBCD group, showing statistically significant differences among the 3 groups (χ²=6.321, 24.651, 6.445, P<0.05). (3) The comparison of survival rate: 289 recipients were followed up for a median time of 6 months. The 1 and 3year rates of recipients were 82% and 77% in the DBD group, 76% and 64% in the DCD group , 84% and 74% in the DBCD group, respectively, with a statistically significant difference among the 3 groups (χ²=7.238, P<0.05).
Conclusion:There is lower incidence of postoperative complications in the recipients undergoing liver transplantation from DBD and DBCD donors, with a good survival rate.