Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Transpl Int. 2012 Jan;25(1):7-12. doi: 10.1111/j.1432-2277.2011.01336.x. Epub 2011 Sep 16.
In living donor liver transplantation (LDLT) for primary biliary cirrhosis (PBC), the majority of donors are genetically related to their recipients, leading to concerns of an earlier recurrence of PBC and a poorer prognosis due to genetic susceptibility. Totally 81 patients who underwent LDLT for PBC were the subjects of the present study. Immunosuppressive agents consisted of tacrolimus and methylprednisolone. In the outpatient clinic, when the aspartate and alanine aminotransferase level exceeded the upper limit of the normal range, the dose of methylprednisolone was increased from 4 to 6 mg/day for several months. Blood was examined every 2 weeks for 3 months and a liver biopsy was performed when aminotransferase levels did not decrease to the upper limit of the normal range after more than 3 months. Five-year survival and recurrence rates were estimated and the prognostic factors were analyzed. The mean observation period was 6.2 years. Five years after LDLT for PBC, the biopsy-proven PBC recurrence rate was 1%. The 5-year patient survival rate was 80%. The nonrelated or blood-related donor factor and number of human leukocyte antigen matches did not correlate with prognosis. PBC recurrence rate after LDLT in our series was lower than that in previous studies.
在原发性胆汁性肝硬化（PBC）的活体肝移植（LDLT）中，大多数供体与受体在基因上是相关的，这导致人们担心 PBC 更早复发和由于遗传易感性导致预后更差。本研究共纳入 81 例接受 LDLT 治疗的 PBC 患者。免疫抑制剂由他克莫司和甲基强的松龙组成。在门诊，当天门冬氨酸氨基转移酶和丙氨酸氨基转移酶水平超过正常范围上限时，甲基强的松龙的剂量会从 4 毫克/天增加到 6 毫克/天，持续数月。每 2 周检查一次血液，持续 3 个月，如果在 3 个月后氨基转移酶水平仍未降至正常范围上限，则进行肝活检。评估了 5 年生存率和复发率，并分析了预后因素。平均观察期为 6.2 年。在 LDLT 治疗 PBC 后的 5 年内，经活检证实的 PBC 复发率为 1%。5 年患者生存率为 80%。非亲缘或血缘相关供体因素和人类白细胞抗原匹配数与预后无关。我们的研究中 LDLT 后 PBC 的复发率低于以往的研究。
