Takeda K, Morioka D, Kumamoto T, Matsuo K, Tanaka K, Endo I, Togo S, Shimada H
Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan.
Transplant Proc. 2009 Nov;41(9):3941-4. doi: 10.1016/j.transproceed.2009.02.094.
A 47-year-old Japanese man was transferred to our hospital because of acute-on-chronic hepatitis B virus infection. On admission, he was suffering from sepsis due to a catheter infection and respiratory failure caused by pulmonary edema and pneumonia, but, as a result of preoperative intensive care, we avoided septic shock. ABO-incompatible liver transplantation (ABO-I-LT) was performed. In accordance with our ABO-I-LT protocol, we administered, rituximab and performed plasma exchange, splenectomy as well as hepatic artery infusion. The patient was discharged 80 days after living donor transplantation (LDLT). However, 136 days after LDLT, he experienced recurrent respiratory failure due to severe pneumonia. At that time, the CD19(+) B-cell count in the peripheral blood flow remained below 1%. We suspected a mixed infection involving Streptococcus pneumonia, Pneumocystis carinii, and fungus. The cause of the complication was overwhelming postsplenectomy infection (OPSI). We started administration of sulfamethoxazole and trimethoprim, ciprofloxacin hydrochloride, and micafungin sodium therapy as well as gamma-globulin. Oxygenation improved gradually; the patient was discharged at 41 days after re-admission. Although this patient survived the OPSI, it was clear that some aspects of the ABO-I-LT protocol should also be altered.
一名47岁的日本男性因慢性乙型肝炎病毒感染急性发作被转至我院。入院时，他因导管感染导致败血症，并因肺水肿和肺炎引发呼吸衰竭，但经过术前重症监护，我们避免了感染性休克。进行了ABO血型不相容肝移植（ABO-I-LT）。按照我们的ABO-I-LT方案，我们给予了利妥昔单抗并进行了血浆置换、脾切除术以及肝动脉灌注。该患者在活体供肝移植（LDLT）后80天出院。然而，LDLT后136天，他因严重肺炎再次出现呼吸衰竭。当时，外周血流中CD19(+) B细胞计数仍低于1%。我们怀疑是肺炎链球菌、卡氏肺孢子虫和真菌的混合感染。并发症的原因是脾切除术后暴发性感染（OPSI）。我们开始给予磺胺甲恶唑和甲氧苄啶、盐酸环丙沙星、米卡芬净钠治疗以及丙种球蛋白。氧合逐渐改善；患者再次入院41天后出院。尽管该患者在OPSI中存活下来，但很明显ABO-I-LT方案的某些方面也应进行调整。
