切换至 "中华医学电子期刊资源库"
高级检索
中华移植杂志(电子版)

中华移植杂志(电子版) ›› 2024, Vol. 18 ›› Issue (06) : 386 -397. doi: 10.3877/cma.j.issn.1674-3903.2024.06.007

专家共识

腹部常温区域机械灌注在以循环标准判定死亡的遗体器官捐献中的临床应用专家共识
中华医学会器官移植学分会   
  • 收稿日期:2024-12-13 出版日期:2024-12-25
  • 基金资助:
    中国器官移植发展基金会科研项目国家卫生健康委员会医疗应急司政府购买服务国家自然科学基金面上项目(81970564,82070670,82170663,82370664,82300744)

Consensus on clinical application of normothermic regional perfusion in donation after circulatory determination of death

of Organ Transplantation of Chinese Medical Association Branch   

  • Received:2024-12-13 Published:2024-12-25
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

中华医学会器官移植学分会. 腹部常温区域机械灌注在以循环标准判定死亡的遗体器官捐献中的临床应用专家共识[J/OL]. 中华移植杂志(电子版), 2024, 18(06): 386-397.

of Organ Transplantation of Chinese Medical Association Branch. Consensus on clinical application of normothermic regional perfusion in donation after circulatory determination of death[J/OL]. Chinese Journal of Transplantation(Electronic Edition), 2024, 18(06): 386-397.

器官移植是治疗终末期器官疾病的最有效方法。 器官短缺是器官移植领域面临的主要挑战之一。 为此,临床上越来越多地使用包括以循环标准判定死亡的遗体器官捐献(DCDD)在内的扩大标准供者器官。 然而,DCDD 供器官因遭受额外的热缺血损伤,严重影响其移植疗效和器官利用率。 大量临床研究表明,常温区域机械灌注(NRP)技术的应用可显著提高DCDD 供器官质量和移植成功率。 目前,我国尚未制订NRP 技术在DCDD 中临床应用的专家共识,这影响了我国DCDD 的规范化与高质量发展。 为改变这一现状,本文总结国际研究进展,依据循证医学原则深入论证,形成《腹部常温区域机械灌注在以循环标准判定死亡的遗体器官捐献中的临床应用专家共识》。 本共识重点介绍DCDD 过程中应用NRP 技术的执行规范及相应循证医学证据,旨在为NRP 技术在DCDD 供器官移植中应用的规范化、标准化提供参考和指导意见,推动我国NRP 技术和DCDD 供器官移植的快速发展。

关键词: 以循环标准判定死亡的遗体器官捐献, 常温区域机械灌注, 器官移植, 执行规范

Organ transplantation is the most effective treatment for end-stage organ disease.One of the major challenges in organ transplantation is organ shortage.For this reason, more and more extended criteria donor organs including those from donation after circulatory determination of death(DCDD) are used in clinical practice.However, DCDD organs suffer from additional warm ischemic damage, which seriously affects transplant outcomes and organ utilization.Recent studies at home and abroad have shown that the application of normothermic regional perfusion (NRP) is able to improve the quality of organs and the success rate of transplantation.At present, an expert consensus on the clinical application of NRP in DCDD is lacking in China, which limits the standardization and high-quality development of DCDD in our country.We summarized the results of clinical studies and conducted in-depth discussions based on the principles of evidence-based medicine, to form this consensus on application of NRP in DCDD.This consensus focuses on the executive specification and corresponding research evidence of applying NRP technology in DCDD, aiming to provide reference opinions and guidance for the standardization of NRP in organ transplantation, and to promote the rapid development of NRP technology and DCDD organ transplantation in China.

Key words: Donation after circulatory determination of death, Normothermic regional perfusion, Organ transplantation, Implementation standards
表1 推荐意见分级的评估、制订与评价系统
证据级别 定义
Ⅰ 同质RCT 的系统评价
单个RCT(可信区间窄)
“全或无”病案系列研究
Ⅱ 同质队列研究的系统评价
单个队列研究(包括低质量RCT,如随访率<80%)
结果研究,生态学研究
Ⅲ 同质病例对照研究的系统评价
单个病例对照研究
Ⅳ 病例系列研究(包括低质量队列及病例对照研究)
Ⅴ 基于经验未严格论证的专家意见
表2 腹部NRP 期间肝脏评价标准汇总
国家 作者 年份 供肝接受标准
法国 Champigneulle 等[44] 2015 AST/ ALT <200 IU/ L(若连续2 次测量>200 IU/ L,应弃用供肝);活检提示脂肪变性<15% ～20%,且无纤维化
Savier 等[45] 2015 AST/ ALT <200 IU/ L(若连续2 次测量>200 IU/ L,应弃用供肝)
Antoine 等[26] 2020 NRP 期间AST/ ALT 水平<4 倍正常上限(≥3 次测量值),活检提示大泡型脂肪变性< 20%,且< 中度纤维化
Muller 等[46] 2020 NRP 期间AST/ ALT 水平<4 倍正常上限,活检提示大泡型脂肪变性<20%
西班牙 Otero 等[47] 2003 活检提示脂肪变性<30%且无慢性肝病征象
Fondevila 等[48] 2007 正常大体外观,活检提示大泡型脂肪变性<30%,无血管性的胆总管功能异常
Jiménez-Galanes 等[49] 2009 NRP 期间AST/ ALT 最高水平<4 倍正常上限
Fondevila 等[6] 2012 无淤血或灌注不良,无脂肪变性或纤维化,无血管性的胆总管功能异常
Rojas-Peña 等[34] 2014 正常大体外观
Miñambres 等[50] 2017 NRP 期间AST/ ALT 最高水平<4 倍正常上限
Jiménez-Romero 等[51] 2019 NRP 期间AST/ ALT 最高水平<4 倍正常上限,正常大体外观,活检提示大泡型脂肪变性<30%
Ruiz 等[52] 2019 NRP 初始AST/ ALT 水平<3 倍正常上限,终末AST/ ALT 水平<4 倍正常上限
Miñambres 等[53] 2020 NRP 期间AST/ ALT 最高水平<4 倍正常上限,正常大体外观
意大利 De Carlis 等[54] 2017 NRP 期间ALT <1 000 IU/ L,血清乳酸水平呈持续下降趋势,正常大体外观,活检提示大泡型脂肪变性<30%且纤维化Ishad 评分<1 分
De Carlis 等[55] 2018 满足≥3 条下述标准:ALT <1 000 IU/ L,血清乳酸水平呈持续下降趋势,正常大体外观,活检提示大泡型脂肪变性<30%且纤维化Ishad 评分<1 分
英国 Butler 等[33] 2014 正常大体外观且基线ALT <200 IU/ L
Oniscu 等[56] 2014 NRP 初始AST/ ALT 水平<3 倍正常上限,终末AST/ ALT 水平<4 倍正常上限,正常大体外观
Georgiades 等[57] 2019 AST/ ALT 水平稳定,血清乳酸水平呈持续下降趋势
Watson 等[8] 2019 正常大体外观,ALT 和血清乳酸水平均呈持续下降趋势
1
Morris PJ.Transplantation-a medical miracle of the 20th century[J].N Engl J Med,2004,351(26):2678-2680.
2
Goldaracena N, Cullen JM, Kim DS, et al.Expanding the donor pool for liver transplantation with marginal donors[J].Int J Surg,2020,82S:30-35.
3
Nemes B, Gámán G, Polak WG, et al.Extended criteria donors in liver transplantation part I: reviewing the impact of determining factors[J].Expert Rev Gastroenterol Hepatol, 2016, 10(7): 827-839.
4
Widmer J, Eden J, Carvalho MF, et al.Machine perfusion for extended criteria donor livers: what challenges remain?[J].J Clin Med,2022,11(17):5218.
5
Sánchez-Fructuoso AI, Prats D, Torrente J, et al.Renal transplantation from non-heart beating donors: a promising alternative to enlarge the donor pool[J].J Am Soc Nephrol, 2000, 11(2):350-358.
6
Fondevila C, Hessheimer AJ, Flores E, et al.Applicability and results of Maastricht type 2 donation after cardiac death liver transplantation[J].Am J Transplant,2012,12(1):162-170.
7
Hessheimer AJ, Coll E, Torres F, et al.Normothermic regional perfusion vs.super-rapid recovery in controlled donation after circulatory death liver transplantation[J].J Hepatol,2019,70(4):658-665.
8
Watson CJE, Hunt F, Messer S, et al. In situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival [J].Am J Transplant,2019,19(6):1745-1758.
9
Savier E, Lim C, Scatton O.Liver transplantation from controlled donation after circulatory death donors with normothermic regional perfusion versus donation after brain death donors[J].Liver Transpl,2022,28(3):508-509.
10
Savier E, Lim C, Rayar M, et al.Favorable outcomes of liver transplantation from controlled circulatory death donors using normothermic regional perfusion compared to brain death donors[J].Transplantation,2020,104(9):1943-1951.
11
Ruiz P, Valdivieso A, Palomares I, et al.Similar results in liver transplantation from controlled donation after circulatory death donors with normothermic regional perfusion and donation after brain death donors: a case-matched single-center study[J].Liver Transpl,2021,27(12):1747-1757.
12
Kootstra G, Daemen JH,Oomen AP.Categories of non-heart-beating donors[J].Transplant Proc,1995,27(5):2893-2894.
13
霍枫, 李智霞, 季茹,等.以循环标准判定死亡的遗体器官捐献分类标准、实施流程及需要注意的问题[J/CD].中华移植杂志:电子版,2024,18(4):213-221.
14
Brubaker AL, Sellers MT, Abt PL, et al.US liver transplant outcomes after normothermic regional perfusion vs standard super rapid recovery[J].JAMA Surg,2024,159(6):677-685.
15
Liang A, Cheng W, Cao P, et al.Effects of machine perfusion strategies on different donor types in liver transplantation:a systematic review and meta-analysis[J].Int J Surg, 2023, 109(11): 3617-3630.
16
Miñambres E, Rubio JJ, Coll E, et al.Donation after circulatory death and its expansion in Spain[J].Curr Opin Organ Transplant,2018,23(1):120-129.
17
Jochmans I, Hessheimer AJ, Neyrinck AP, et al.Consensus statement on normothermic regional perfusion in donation after circulatory death: Report from the European Society for Organ Transplantation′s Transplant Learning Journey[J].Transpl Int,2021,34(11):2019-2030.
18
De Beule J, Vandendriessche K, Pengel LHM, et al.A systematic review and meta-analyses of regional perfusion in donation after circulatory death solid organ transplantation[J].Transpl Int, 2021,34(11):2046-2060.
19
Coll E, Miñambres E, Sánchez-Fructuoso A, et al.Uncontrolled donation after circulatory death: a unique opportunity [ J].Transplantation,2020,104(8):1542-1552.
20
Schurink IJ, de Goeij FHC, Habets LJM, et al.Salvage of declined extended-criteria DCD livers using in situ normothermic regional perfusion[J].Ann Surg,2022,276(4): e223-e230.
21
Ghinolfi D, Melandro F, Torri F, et al.The role of sequential normothermic regional perfusion and end-ischemic normothermic machine perfusion in liver transplantation from very extended uncontrolled donation after cardiocirculatory death[J].Artif Organs,2023,47(2):432-440.
22
Lazzeri C, Bonizzoli M, Marra F, et al.Uncontrolled donation after circulatory death and liver transplantation: evidence and unresolved issues[J].Minerva Anestesiol,2020,86(2):196-204.
23
Melandro F, Basta G, Torri F, et al.Normothermic regional perfusion in liver transplantation from donation after cardiocirculatory death: Technical, biochemical, and regulatory aspects and review of literature[J].Artif Organs,2022,46(9):1727-1740.
24
Manara AR, Murphy PG, O′Callaghan G.Donation after circulatory death[J].Br J Anaesth,2012,108(Suppl 1) :i108-i121.
25
Hessheimer AJ, Riquelme F, Fundora-Suárez Y, et al.Normothermic perfusion and outcomes after liver transplantation[J].Transplant Rev (Orlando),2019,33(4):200-208.
26
Antoine C, Jasseron C, Dondero F, et al.Liver transplantation from controlled donors after circulatory death using normothermic regional perfusion: an initial French experience[J].Liver Transpl,2020,26(11):1516-1521.
27
Gaurav R, Butler AJ, Kosmoliaptsis V, et al.Liver transplantation outcomes from controlled circulatory death donors:SCS vs in situ NRP vs ex situ NMP[J].Ann Surg,2022,275(6):1156-1164.
28
De Carlis R, Paolo Muiesan, Taner B.Donation after circulatory death: novel strategies to improve the liver transplant outcome[J].J Hepatol,2023,78(6):1169-1180.
29
Ethics Committee, American College of Critical Care Medicine;Society of Critical Care Medicine.Recommendations for nonheartbeating organ donation.A position paper by the Ethics Committee, American College of Critical Care Medicine, Society of Critical Care Medicine[J].Crit Care Med, 2001, 29(9): 1826-1831.
30
Pérez Redondo M, Alcántara Carmona S, Fernández Simón I, et al.Implementation of a mobile team to provide normothermic regional perfusion in controlled donation after circulatory death: pilot study and first results[J].Clin Transplant,2020,34(8): e13899.
31
Figini MA, Paredes-Zapata D,Juan EO,et al.Mobile extracorporeal membrane oxygenation teams for organ donation after circulatory death[J].Transplant Proc,2020,52(5):1528-1535.
32
Wall AE, Merani S, Batten J, et al.American society of transplant surgeons normothermic regional perfusion standards: ethical, legal,and operational conformance[J].Transplantation, 2024, 108(8):1655-1659.
33
Butler AJ, Randle LV, Watson CJ.Normothermic regional perfusion for donation after circulatory death without prior heparinization[J].Transplantation,2014,97(12):1272-1278.
34
Rojas-Peña A, Sall LE, Gravel MT, et al.Donation after circulatory determination of death: the university of michigan experience with extracorporeal support[J].Transplantation, 2014, 98(3): 328-334.
35
Foss S, Nordheim E, Sørensen DW, et al.First scandinavian protocol for controlled donation after circulatory death using normothermic regional perfusion[J].Transplant Direct, 2018, 4(7): e366.
36
Manara A, Shemie SD, Large S, et al.Maintaining the permanence principle for death during in situ normothermic regional perfusion for donation after circulatory death organ recovery:a United Kingdom and Canadian proposal[J].Am J Transplant, 2020, 20(8): 2017-2025.
37
Hessheimer AJ, Polak W, Antoine C, et al.Regulations and procurement surgery in DCD liver transplantation: expert consensus guidance from the International Liver Transplantation Society[J].Transplantation,2021,105(5):945-951.
38
Croome KP, Brown TE, Mabrey RL, et al.Development of a portable abdominal normothermic regional perfusion ( A-NRP)program in the United States[J].Liver Transpl, 2023, 29(12):1282-1291.
39
Sellers MT, Nassar A, Alebrahim M, et al.Early United States experience with liver donation after circulatory determination of death using thoraco-abdominal normothermic regional perfusion: a multiinstitutional observational study[J].Clin Transplant,2022,36(6):e14659.
40
Sousa Da, Silva RX, Weber A, et al.Machine perfusion in liver transplantation[J].Hepatology,2022,76(5):1531-1549.
41
Tingle SJ, Figueiredo RS, Moir JA, et al.Machine perfusion preservation versus static cold storage for deceased donor kidney transplantation[J].Cochrane Database Syst Rev, 2019, 3(3):CD011671.
42
Ghinolfi D, Dondossola D, Rreka E, et al.Sequential use of normothermic regional and ex situ machine perfusion in donation after circulatory death liver transplant[J].Liver Transpl, 2021, 27(3):385-402.
43
Ghinolfi D, Melandro F, Torri F, et al.The role of sequential normothermic regional perfusion and end-ischemic normothermic machine perfusion in liver transplantation from very extended uncontrolled donation after cardiocirculatory death[J].Artif Organs,2023,47(2):432-440.
44
Champigneulle B, Fieux F, Cheisson G, et al.French survey of the first three-years of liver transplantation activity from uncontrolled donors deceased after cardiac death[J].Anaesth Crit Care Pain Med,2015,34(1):35-39.
45
Savier E, Dondero F, Vibert E, et al.First experience of liver transplantation with type 2 donation after cardiac death in France[J].Liver Transpl,2015,21(5):631-643.
46
Muller X, Mohkam K, Mueller M, et al.Hypothermic oxygenated perfusion versus normothermic regional perfusion in liver transplantation from controlled donation after circulatory death: first international comparative study[J].Ann Surg,2020,272(5):751-758.
47
Otero A, Gómez-Gutiérrez M, Suárez F, et al.Liver transplantation from Maastricht category 2 non-heart-beating donors [ J ].Transplantation,2003,76(7):1068-1073.
48
Fondevila C, Hessheimer AJ, Ruiz A, et al.Liver transplant using donors after unexpected cardiac death:novel preservation protocol and acceptance criteria[J].Am J Transplant,2007,7(7):1849-1855.
49
Jiménez-Galanes S, Meneu-Diaz MJ, Meneu-Diza MJ, et al.Liver transplantation using uncontrolled non-heart-beating donors under normothermic extracorporeal membrane oxygenation [ J].Liver Transpl,2009,15(9):1110-1118.
50
Miñambres E, Suberviola B, Dominguez-Gil B, et al.Improving the outcomes of organs obtained from controlled donation after circulatory death donors using abdominal normothermic regional perfusion[J].Am J Transplant,2017,17(8):2165-2172.
51
Jiménez-Romero C, Manrique A, Calvo J, et al.Liver transplantation using uncontrolled donors after circulatory death: a 10-year single-center experience[J].Transplantation, 2019, 103(12):2497-2505.
52
Ruiz P, Gastaca M, Bustamante FJ, et al.Favorable outcomes after liver transplantation with normothermic regional perfusion from donors after circulatory death: a single-center experience [ J ].Transplantation,2019,103(5):938-943.
53
Miñambres E, Ruiz P, Ballesteros MA, et al.Combined lung and liver procurement in controlled donation after circulatory death using normothermic abdominal perfusion.Initial experience in two Spanish centers[J].Am J Transplant,2020,20(1):231-240.
54
De Carlis R, Di Sandro S, Lauterio A, et al.Successful donation after cardiac death liver transplants with prolonged warm ischemia time using normothermic regional perfusion[J].Liver Transpl,2017,23(2):166-173.
55
De Carlis R, Di Sandro S,Lauterio A,et al.Liver grafts from donors after circulatory death on regional perfusion with extended warm ischemia compared with donors after brain death[J].Liver Transpl,2018,24(11):1523-1535.
56
Oniscu GC, Randle LV, Muiesan P, et al. In situ normothermic regional perfusion for controlled donation after circulatory death--the United Kingdom experience[J].Am J Transplant, 2014, 14(12):2846-2854.
57
Georgiades F, Hosgood SA, Butler AJ, et al.Use of ex vivo normothermic machine perfusion after normothermic regional perfusion to salvage a poorly perfused DCD kidney[J].Am J Transplant,2019,19(12):3415-3419.
58
Parikh CR, Hall IE, Bhangoo RS, et al.Associations of perfusate biomarkers and pump parameters with delayed graft function and deceased donor kidney allograft function[J].Am J Transplant,2016,16(5):1526-1539.
59
Peris A, Lazzeri C, Bonizzoli M, et al.A metabolic approach during normothermic regional perfusion in uncontrolled donors after circulatory death-a pilot study[J].Clin Transplant,2018,32(10):e13387.
60
张兴.心脏死亡供者与活体供者肾移植早期预后比较及影响因素分析[D].杭州: 浙江大学,2016.
61
van Leeuwen OB, Bodewes SB, Porte RJ, et al.Excellent long-term outcomes after sequential hypothermic and normothermic machine perfusion challenges the importance of functional donor warm ischemia time in DCD liver transplantation[J].J Hepatol, 2023, 79(6):e244-e245.
62
Hessheimer AJ, de la Rosa G, Gastaca M, et al.Abdominal normothermic regional perfusion in controlled donation after circulatory determination of death liver transplantation: outcomes and risk factors for graft loss[J].Am J Transplant,2022,22(4):1169-1181.
63
Truog RD, Flescher A, Ladin K.Normothermic regional perfusionthe next frontier in organ transplants?[J].JAMA,2023,329(24):2123-2124.
64
Croome KP, Barbas AS, Whitson B, et al.American Society of Transplant Surgeons recommendations on best practices in donation after circulatory death organ procurement[J].Am J Transplant,2023,23(2):171-179.
65
Fondevila C, Estébanez B, Hessheimer AJ.Practical considerations for implementation of abdominal normothermic regional perfusion[J].Liver Transpl,2023,29(12):1255-1257.
66
DeCamp M, Snyder Sulmasy L, Fins JJ.Point: does normothermic regional perfusion violate the ethical principles underlying organ procurement? Yes[J].Chest,2022,162(2):288-290.
67
James L, Parent B, Moazami N, et al.Counterpoint: does normothermic regional perfusion violate the ethical principles underlying organ procurement? No[J].Chest,2022,162(2):290-292.
68
Egan TM, Requard JJ 3rd.Ethics of normothermic regional perfusion for donors and definition of death[J].Chest,2023,163(5): e248-e249.
69
Slessarev M, Gofton T, Shemie SD.Ensuring the permanent cessation of brain function during normothermic regional perfusion[J].Transplantation,2022,106(9):1726-1727.
70
Patrono D, Zanierato M, Vergano M, et al.Normothermic regional perfusion and hypothermic oxygenated machine perfusion for livers donated after controlled circulatory death with prolonged warm ischemia time: a matched comparison with livers from brain-dead donors[J].Transpl Int,2022,35:10390.
[1] 霍枫, 李智霞, 季茹, 谭晓宇, 范晓礼, 叶啟发. 以循环标准判定死亡的遗体器官捐献分类标准、实施流程及需要注意的问题[J/OL]. 中华移植杂志(电子版), 2024, 18(04): 213-221.
[2] 江文诗, 侯峰忠. 全球视野下中国人体器官捐献事业的高质量发展:2010～2024[J/OL]. 中华移植杂志(电子版), 2024, 18(04): 204-212.
[3] 裘妃, 高志刚, 汪伟, 王晓豪, 杨子浩, 陈青江, 盛美君, 赵杭燕. 儿童器官获取组织和器官移植管理体系的探索与实践[J/OL]. 中华移植杂志(电子版), 2024, 18(02): 93-97.
[4] 巨春蓉, 门同义, 薛武军. 实体器官移植后难治性/耐药性巨细胞病毒感染诊疗进展[J/OL]. 中华移植杂志(电子版), 2024, 18(02): 86-92.
[5] 尚丽红, 武小桐, 李宁, 石韶华, 王志华, 朱琳茹, 周华. 非HLA抗体检测方法研究进展[J/OL]. 中华移植杂志(电子版), 2024, 18(01): 60-64.
[6] 王惠英, 孙永康, 武小桐. 省级器官获取组织与医疗机构间协同联动提高器官捐献率的方法探讨[J/OL]. 中华移植杂志(电子版), 2024, 18(01): 12-16.
[7] 巨春蓉, 孙启全, 薛武军. 器官移植受者非结核分枝杆菌病诊疗进展[J/OL]. 中华移植杂志(电子版), 2024, 18(01): 1-6.
[8] 贾俊君, 殳儆, 唐秋梅, 丁维燕, 郑树森. 叙事医学在器官移植中的应用及价值[J/OL]. 中华移植杂志(电子版), 2023, 17(06): 381-384.
[9] 季茹, 赵婕, 程子韵, 蒲苗, 赵洪涛, 霍枫. 美国器官移植体系未来发展指导意见及对我国的启示[J/OL]. 中华移植杂志(电子版), 2023, 17(06): 332-337.
[10] 江文诗, 何湘湘. 全球及我国器官捐献发展特征分析与学科建设[J/OL]. 中华移植杂志(电子版), 2023, 17(05): 280-286.
[11] 中华医学会器官移植学分会, 中国医师协会器官移植医师分会, 上海医药行业协会. 中国肝、肾移植受者霉酚酸类药物应用专家共识(2023版)[J/OL]. 中华移植杂志(电子版), 2023, 17(05): 257-272.
[12] 中国康复医学会器官移植康复专业委员会. 成人实体器官移植后糖尿病管理专家共识[J/OL]. 中华移植杂志(电子版), 2023, 17(04): 205-220.
[13] 巨春蓉, 何建行, 钟南山. 咪唑立宾在器官移植领域的应用及展望[J/OL]. 中华移植杂志(电子版), 2023, 17(04): 227-231.
[14] 艾紫叶, 李玲, 何重香, 黄伟, 叶啟发. 猪器官异种移植研究进展[J/OL]. 中华移植杂志(电子版), 2023, 17(03): 186-191.
[15] 杨锦然, 李新长, 何小平, 傅俊, 龙成美, 陈志铭. 不破坏膈肌式肝肾联合获取术总结分析[J/OL]. 中华移植杂志(电子版), 2023, 17(03): 146-151.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号