Department of Anesthesia and Intensive Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Minerva Anestesiol. 2010 Jul;76(7):550-3.
The aim of this paper was to describe a case of acute liver failure treated with total hepatectomy, recombinant activated factor VII and rescue liver transplantation. We reported our experience with a 51-year-old-woman who developed a massive portal thrombosis after cadaveric liver transplantation for hepatic epithelioid hemangioendothelioma and who then required a total hepatectomy and porto-caval shunt as a bridge procedure while waiting for an urgent new liver transplantation. Subsequently, the patient developed severe hemodynamic instability, massive abdominal and mucosal bleeding and acute renal failure that were managed with infusion of high doses of inotropes, red blood cells and fresh frozen plasma as well as continuous veno-venous hemofiltration. Due to persistent, uncontrolled bleeding, we considered the off-label use of rFVIIa. This caused a correction of the prothrombin times and allowed for sufficient hemostasis. The patient received a new cadaveric liver that was reperfused 38 hours after the first graft was removed. The transplanted liver showed immediate recovery, the hemodynamics ameliorated and the patient was fully awake at day five. In the case of an anhepatic phase complicated by severe bleeding that is unresponsiveness to several transfusions, a single administration of rFVIIa should be considered as a rescue therapy to control massive bleeding.
本文旨在描述 1 例采用肝全部切除术、重组活化凝血因子 VII （recombinant activated factor VII，rFVIIa）和抢救性肝移植治疗的急性肝功能衰竭病例。我们报告了 1 例 51 岁女性的治疗经验，该患者因肝脏上皮样血管内皮细胞瘤而行尸体供肝肝移植后发生门静脉主干血栓形成，在等待紧急新肝移植期间，行肝全部切除术和门腔静脉分流术作为桥接治疗。随后，患者出现严重的血流动力学不稳定、大量腹腔和黏膜出血以及急性肾功能衰竭，通过输注大剂量正性肌力药、红细胞和新鲜冰冻血浆以及连续静脉-静脉血液滤过进行治疗。由于持续、无法控制的出血，我们考虑使用 rFVIIa 进行超适应证治疗。该治疗纠正了凝血酶原时间，并实现了充分止血。患者接受了新的尸体供肝，在第 1 个移植物取出后 38 小时重新灌注。移植肝立即恢复，血流动力学改善，患者在第 5 天完全清醒。在发生肝无功能期合并严重出血且对多次输血无反应的情况下，应考虑单次 rFVIIa 给药作为抢救性治疗以控制大出血。
