Patrono Damiano, Tandoi Francesco, Rizza Giorgia, Catalano Giorgia, Mirabella Stefano, Celoria Piero, Corcione Silvia, De Rosa Francesco Giuseppe, Salizzoni Mauro, Romagnoli Renato
General Surgery 2U - Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.
Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy.
Transpl Infect Dis. 2017 Jun;19(3). doi: 10.1111/tid.12685. Epub 2017 Apr 13.
Because of widespread organ shortage, the transplant community has been exploiting more and more so-called "extended criteria" donors. In this scenario, liver grafts harboring benign tumors or large cysts represent an infrequent but potentially valuable source of viable grafts. We depict a challenging case of liver transplantation performed using a graft harboring two large Echinococcus granulosus hydatid cysts in close proximity with the hilar plate and complicated by cystobiliary communication. Although liver transplantation using grafts with hydatid cyst has been rarely reported (three published cases), our case was peculiar as one of the cysts was located close to the hilum and was ruptured into the left hepatic duct. The graft was finally accepted taking into account the low risk profile of the recipient, the good quality and size of the remnant liver parenchyma, and only after complete resection of the cysts was achieved. Although the recipient had a complication due to biliary confluence necrosis, at 10-months follow-up he is in good health with normal hepatic function, and a graft that could have been otherwise discarded was successfully used. The decision process along with technical and management issues are discussed.
由于器官普遍短缺，移植界越来越多地使用所谓的“扩大标准”供体。在这种情况下，带有良性肿瘤或大囊肿的肝移植供体虽然少见，但却是潜在的有价值的活体供体来源。我们描述了一例具有挑战性的肝移植病例，该移植使用的供肝带有两个紧邻肝门板的巨大细粒棘球绦虫包虫囊肿，并伴有囊肿与胆管相通。尽管使用带有包虫囊肿的供肝进行肝移植的报道很少（已发表3例），但我们的病例较为特殊，因为其中一个囊肿位于肝门附近并破裂进入左肝管。考虑到受者的低风险状况、残余肝实质的良好质量和大小，并且仅在囊肿完全切除后，最终接受了该供肝。尽管受者因胆管汇合处坏死出现了并发症，但在10个月的随访中，他健康状况良好，肝功能正常，一个原本可能被丢弃的供肝得以成功使用。本文讨论了决策过程以及技术和管理问题。
