Sakamoto Seisuke, Haga Hironori, Egawa Hiroto, Kasahara Mureo, Ogawa Kohei, Takada Yasutsugu, Uemoto Shinji
Department of Surgery, Kyoto University, Kyoto, Japan.
Pediatr Transplant. 2008 Mar;12(2):167-73. doi: 10.1111/j.1399-3046.2007.00718.x.
Infants with ALF occasionally have the most urgent need for a liver transplant. In urgent situations for liver transplantation, LDLT has been advocated. Between July 1995 and April 2004, medical records of 15 infants undergoing LDLT for ALF of unknown etiology were reviewed and their outcomes were compared with infants undergoing LDLT for other liver diseases. They received LLS (n = 9), MS (n = 3), and RMS (n = 3) grafts. Eight technical complications occurred, with a similar incidence for LDLT and the other liver diseases. On the other hand, the liver biopsies after LDLT showed a significantly higher incidence of ACR with centrilobular injuries. Ten patients died after primary LDLT because of refractory rejection (n = 6), rotavirus infection (n = 2), chronic rejection (n = 1), and surgical complications (n = 1). With a median follow-up of 7.0 months, five-yr graft and patient survival rates were 17.8% and 26.7%, respectively. In conclusion, the outcome of LDLT for ALF in infants, especially cases with unknown etiology, was unsatisfactory and refractory rejection often led to liver failure. From our observation the centrilobular changes were characteristics of ACR in infantile LDLT for cryptogenic ALF.
急性肝衰竭（ALF）患儿有时最急需进行肝移植。在肝移植的紧急情况下，活体肝移植（LDLT）受到推崇。回顾了1995年7月至2004年4月期间15例因病因不明的ALF接受LDLT的婴儿的病历，并将其结果与因其他肝脏疾病接受LDLT的婴儿进行比较。他们接受了左外侧叶肝移植（LLS，n = 9）、中叶肝移植（MS，n = 3）和右中叶肝移植（RMS，n = 3）。发生了8例技术并发症，LDLT与其他肝脏疾病的发生率相似。另一方面，LDLT后的肝活检显示伴有小叶中心损伤的急性细胞性排斥反应（ACR）发生率显著更高。10例患者在首次LDLT后死亡，原因包括难治性排斥反应（n = 6）、轮状病毒感染（n = 2）、慢性排斥反应（n = 1）和手术并发症（n = 1）。中位随访7.0个月，5年移植肝和患者生存率分别为17.8%和26.7%。总之，婴儿ALF行LDLT的结果，尤其是病因不明的病例，并不理想，难治性排斥反应常导致肝衰竭。根据我们的观察，小叶中心改变是婴儿隐源性ALF行LDLT时ACR的特征。
