Bustamante M, Castroagudín J F, Gonzalez-Quintela A, Martinez J, Segade F R, Fernandez A, Galban C, Varo E
Liver Transplantation Unit, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain.
Hepatogastroenterology. 2000 Sep-Oct;47(35):1343-6.
BACKGROUND/AIMS: Recently, total hepatectomy and temporary porto-caval shunt has been indicated in surgical complications of liver transplantation. Four cases of liver transplantation which presented liver hemorrhage at the time of implant, and a 5th case with surgical trauma of hepatic hilum are presented.
The graft was removed and a porto-caval shunt was performed in all patients. Retransplantation was possible in all recipients, after an anhepatic period of 16-24 hours.
Early persistent ionic hypocalcemia and late olyguric renal failure were the most constant and prominent complications during the anhepatic period. Two patients died of renal failure and respiratory distress syndrome at 6 and 28 days, respectively, after liver transplantation. The other 3 patients are alive and without complications at 48, 33 and 11 months of follow-up.
Total hepatectomy with a temporary porto-caval shunt and later retransplantation must be considered as a useful procedure for surgical complications of liver transplantation which may not be treated using other techniques. Special attention should be paid to preserve renal function in the anhepatic state in order to improve survival in similar cases of two-stage liver transplantation.
背景/目的：最近，全肝切除术和临时性门腔静脉分流术已被应用于肝移植的外科并发症。本文报告了4例肝移植植入时出现肝出血的病例，以及第5例肝门部手术创伤的病例。
所有患者均切除移植物并进行门腔静脉分流术。在无肝期16 - 24小时后，所有受者均可行再次移植。
无肝期最常见且突出的并发症是早期持续性离子钙降低和晚期少尿性肾衰竭。2例患者分别在肝移植术后6天和28天死于肾衰竭和呼吸窘迫综合征。其他3例患者在随访48、33和11个月时存活且无并发症。
对于肝移植的外科并发症，若无法用其他技术治疗，全肝切除术联合临时性门腔静脉分流术及随后的再次移植术应被视为一种有效的治疗方法。在无肝状态下应特别注意保护肾功能，以提高类似两阶段肝移植病例的生存率。
