Kaibori Masaki, Ha-Kawa Sang Kil, Uchida Yoichiro, Ishizaki Morihiko, Hijikawa Takeshi, Saito Takamichi, Imamura Atsushi, Hirohara Junko, Uemura Yoshiko, Tanaka Koichi, Kamiyama Yasuo
Department of Surgery, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka, 570-8507, Japan.
Dig Dis Sci. 2006 Nov;51(11):2013-7. doi: 10.1007/s10620-006-9534-1. Epub 2006 Sep 15.
Recurrence of hepatitis C virus (HCV) after living donor liver transplantation was investigated using technetium-99m- diethylenetriaminepentaacetic acid-galactosyl human serum albumin (Tc-99m-GSA) liver scintigraphy. Four patients with decompensated cirrhosis due to HCV infection were retrospectively reviewed in this study. Scintigraphy was performed to determine the hepatic uptake ratio of the tracer corrected for disappearance from the blood, as well as the maximal removal rate of the tracer by hepatocytes, as parameters of hepatic functional reserve. In all patients, serum HCV ribonucleic acid (RNA) was detected 3 months after transplantation. The corrected hepatic uptake ratio and removal rate showed little change after transplantation in two patients without the recurrence of HCV infection. In another two patients, these levels were decreased at 3 months after transplantation. In one patient, recurrent HCV infection was diagnosed by confirmatory histologic examination at 12 months after transplantation. In the other patient, both levels declined further at 8 months. Although treatment was initiated with a combination of interferon plus ribavirin, this patient died of progressive hepatic failure. In conclusion, a decrease in scintigraphic parameters at 3 months after transplantation suggests recurrent HCV infection affecting the graft. Tc-99m-GSA liver scintigraphy is a useful noninvasive method for evaluating graft functional reserve.
利用锝-99m-二乙三胺五乙酸-半乳糖基人血清白蛋白（Tc-99m-GSA）肝脏闪烁扫描术对活体供肝移植后丙型肝炎病毒（HCV）的复发情况进行了研究。本研究对4例因HCV感染导致失代偿性肝硬化的患者进行了回顾性分析。进行闪烁扫描以确定经血液中示踪剂消失校正后的肝脏摄取率，以及肝细胞对示踪剂的最大清除率，作为肝功能储备的参数。所有患者在移植后3个月均检测到血清HCV核糖核酸（RNA）。在2例未发生HCV感染复发的患者中，校正后的肝脏摄取率和清除率在移植后变化不大。在另外2例患者中，这些指标在移植后3个月时下降。1例患者在移植后12个月经组织学检查确诊为HCV感染复发。另一例患者的这两个指标在8个月时进一步下降。尽管开始使用干扰素加利巴韦林联合治疗，但该患者死于进行性肝功能衰竭。总之，移植后3个月闪烁扫描参数的下降提示复发性HCV感染影响移植物。Tc-99m-GSA肝脏闪烁扫描术是评估移植物功能储备的一种有用的非侵入性方法。
