Hayashi H, Shimizu K, Tani T, Takamura H, Takeshita M, Funaki K, Kitagawa H, Kayahara M, Ota T, Miwa K
Department of Gastroenterologic Surgery, Kanazawa University, Kanazawa, Japan.
Transplant Proc. 2005 Mar;37(2):1101-3. doi: 10.1016/j.transproceed.2005.01.038.
A 54-year-old female diagnosed with primary biliary cirrhosis (PBC) 10 years earlier was referred for a living donor liver transplant (LDLT). During her workup, she developed pulmonary edema and respiratory failure due to aspiration pneumonia, which required artificial ventilation. The PaO2/FiO2 (P/F) ratio at that time was 60. Although continuous hemodiafiltration (CHDF) and plasma exchange (PE) were initiated, improvement in the P/F ratio was limited to 133. As transplantation was the only approach to save this patient, we performed LDLT using a right lobe graft aided by percutaneous cardiopulmonary support (PCPS). The graft weight was 650 g and the graft weight/recipient weight ratio was 1.6%. During LDLT, the patient's cardiopulmonary function was stable with PCPS, and the surgical procedure was completed without complications. Following the surgery, she continued to have high-end inspiratory pressure and progressed to the chronic phase of adult respiratory distress syndrome (ARDS). We treated her with low-dose steroid therapy and she improved gradually. The patient was weaned off mechanical ventilation and was discharged approximately 25 weeks after LDLT. In the condition of cardiac or respiratory failure, cadaveric liver transplantation using plasmapheresis is contraindicated because of the associated high mortality rate. Our case suggests that if infections are controlled, a patient with multiple organ failure (MOF) due to end-stage liver disease might be successfully treated with LDLT aided by plasmapheresis and PCPS.
一名54岁女性，10年前被诊断为原发性胆汁性肝硬化（PBC），前来接受活体供肝移植（LDLT）评估。在检查过程中，她因吸入性肺炎出现肺水肿和呼吸衰竭，需要进行人工通气。当时的动脉血氧分压/吸入氧分数（PaO2/FiO2，P/F）比值为60。尽管启动了持续血液透析滤过（CHDF）和血浆置换（PE），但P/F比值仅改善至133。由于移植是挽救该患者的唯一方法，我们在经皮心肺支持（PCPS）辅助下，使用右叶供肝进行了LDLT。供肝重量为650 g，供肝重量/受者体重比为1.6%。在LDLT过程中，患者在PCPS辅助下心肺功能稳定，手术过程顺利，无并发症发生。术后，她持续存在高吸气压力，并进展为成人呼吸窘迫综合征（ARDS）慢性期。我们采用小剂量激素治疗，她逐渐好转。患者脱机，在LDLT后约25周出院。在存在心脏或呼吸衰竭的情况下，由于相关死亡率高，禁忌使用血浆置换进行尸体肝移植。我们的病例表明，如果感染得到控制，终末期肝病导致多器官功能衰竭（MOF）的患者可能通过血浆置换和PCPS辅助的LDLT成功治疗。
