The Clinical Research On The Organ Donation After Death In Children And Application Of Liver Graft

Objective: To carry out the work of organ donation after death in children, increase the donor pool, alleviate the organ shortage and apply the liver graft in clinical.Methods: 1 A retrospective analysis of organ donation after death in children from2014 March to 2015 March in Beijing Friendship Hospital was applied. All the works were according to the Chinese Human Organ Donation Guideline. All the data of the donors were collected including: basic docment, history, examination, assessment and maintenance of the function of important organs, harvesting process,clinical application.2 The applications of liver grafts from donation after cardiac death children in pediatric liver transplantation. Clinical analysis of the pediatric liver transplantation from donation after death in children between June 2013 and March 2015 in Beijing Friendship Hospital was applied. Data collected including age,gender, diagnosis, indication,data during operation. Liver function recovery, vascular complications, biliary complications of the recipients after liver transplantation were recorded, survival and the cause of death were analyzed.3. The applications of liver grafts from donation after cardiac death children in adult liver transplantation. Clinical analysis was applied in adult liver transplantation from donation after death children between June 2013 and March 2015 in Beijing Friendship Hospital(over 18 years); including native hospital donated and Organ Shared Network distribution. The same as pediatric liver transplantation, the donors and recipients data were collected.Focus on the recipient selection, operation protocol, prevention and treatment of small-for-size syndrome and vascular complications.Results: 1 Between 2014 March to 2015 March, 13 cases of donation were performed in Beijing Friendship Hospital, 46 cases of potential donors were found, the success rate of donation was 28.3%. 10 cases of donation were children in 29 potential donors, the success rate was 34.5%. 10 liver grafts, 22 kidneys and 1 heart wereharvested. The youngest donors was 7days, the minimum weight was 3Kg.2 liver grafts and 2 kidney grafts were abandoned without clinical application; 8 liver grafts were applied in clinical, the recipients were recovered well. 2 kidney grafts recipients happened delayed graft function recovery, 1 case died early after operation.2. 51 cases pediatric liver transplantation were performed using the grafts from donation after cardiac death in children, the survival rate of both the patient and graft in 6 months and 1 year were 87.1%,87.1% respectively, No PNF was occurred, DGF was occurred in 1 case(2%). HAT were occurred in 7 patients early postoperative(17.6%),2 cases were happened with PVT(3.9%) and 5 cases were happened with billary complication(9.8%). 7 patients were died, 1 cases died of respiratory and circulatory failure early postoperative, 2 cases died of graft failure, 1 cases died from measles virus infection two months after operation, 1cases died of paratyphoid half a year after operation, 2 cases give up the treatment and death in home.3. 16 adult cases of liver transplant were performed using the graft from donation after cardiac death in children from June 2013 to March2015 in Beijing Friendship Hospital, 15 cases with classical without bypass, 1 cases with piggyback.9 patients received portal vein blood flow adjustment intraoperative. 1 cases of small-for-size syndrome was happened,HAT was occurred in 2 cases. 1 of 16 patients was died, the others were alive.Conclusion: Liver transplantation is an effective method for treatment of children with end-stage liver disease and metabolic disease, The donation rate in children after death is higher than adult.It is very important to evaluate and maintain organ funtion, will directly affect the results of recipients. The incidence of HAT using DCD donors was significantly higher than LDLT. The adult liver transplantation using the graft from children after death will obtain good result with the reasonable selected recipients.blood flow adjustment of PV was necessary to avoid SFSS.