活体供肝肝移植治疗药物性急性肝衰竭的良好疗效：单中心经验

Good outcome of living donor liver transplantation in drug-induced acute liver failure: A single-center experience.

作者信息

Choudhary Narendra Singh, Saigal Sanjiv, Saraf Neeraj, Rastogi Amit, Goja Sanjay, Bhangui Prashant, Vohra Vijay, Govil Deepak, Soin Arvinder S

机构信息

Institute of Liver Transplantation and Regenerative Medicine, Medanta, The Medicity, Gurgaon, India.

Institute of Liver Transplant Anesthesia, Medanta, The Medicity, Gurgaon, India.

出版信息

Clin Transplant. 2017 Mar;31(3). doi: 10.1111/ctr.12907.

DOI:10.1111/ctr.12907

PMID:28054388

Abstract

INTRODUCTION

Drug-induced acute liver failure (ALF) is associated with high mortality. There is limited literature on results of living donor liver transplantation (LDLT).

MATERIAL AND METHODS

The study was conducted at a tertiary care center in North India. All patients who received LDLT for drug-induced ALF were included. The data are shown as median (IQR).

RESULTS

A total of 18 patients (15 females and three males), aged 34 (25-45) years, underwent LDLT for drug-induced liver injury (DILI)-related ALF. Etiology of ALF was antitubercular medications (n=14), orlistat (n=1), flutamide (n=1), and complementary alternative medications (n=2). The baseline parameters were as following: bilirubin 17.7 (16.3-23.8) mg/dL, INR 3.3 (2.5-4.0), jaundice encephalopathy interval 6 (3-17.5) days, arterial ammonia 109 μmol/L (73-215), Model for End-Stage Liver Disease (MELD) 24 (18-33), grade of encephalopathy 2 (1-4), which progressed to grade 3 (3-4) before transplantation. All patients underwent right lobe LDLT; hospital stay was 17 (13-22) days, and ICU stay was 5 (5-7) days. Two patients died in the first month after liver transplantation due to sepsis and multi-organ failure; the rest of the patients are alive and doing well at a follow-up of 50 (4-82 months).

CONCLUSION

Good outcomes can be obtained by LDLT for drug-induced ALF.

摘要

引言

药物性急性肝衰竭（ALF）死亡率高。关于活体肝移植（LDLT）结果的文献有限。

材料与方法

本研究在印度北部的一家三级医疗中心进行。纳入所有因药物性ALF接受LDLT的患者。数据以中位数（四分位间距）表示。

结果

共有18例患者（15例女性，3例男性），年龄34（25 - 45）岁，因药物性肝损伤（DILI）相关的ALF接受了LDLT。ALF的病因包括抗结核药物（n = 14）、奥利司他（n = 1）、氟他胺（n = 1）和补充替代药物（n = 2）。基线参数如下：胆红素17.7（16.3 - 23.8）mg/dL，国际标准化比值（INR）3.3（2.5 - 4.0），黄疸至肝性脑病间隔时间6（3 - 17.5）天，动脉血氨109 μmol/L（范围73 - 215），终末期肝病模型（MELD）评分24（18 - 33），肝性脑病分级2（1 - 4），移植前进展至3级（3 - 4）。所有患者均接受了右半肝LDLT；住院时间为17（13 - 22）天，重症监护病房（ICU）停留时间为5（5 - 7）天。2例患者在肝移植后第一个月因败血症和多器官功能衰竭死亡；其余患者在50（4 - 82）个月的随访中存活且情况良好。