Sakamoto Seisuke, Sasaki Kengo, Uchida Hajime, Narumoto Soichi, Kitajima Toshihiro, Irie Rie, Fukuda Akinari, Yoshioka Takako, Kasahara Mureo
Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Department of Pathology, National Center for Child Health and Development, Tokyo, Japan.
Hepatol Res. 2018 Feb;48(3):E367-E371. doi: 10.1111/hepr.12968. Epub 2017 Sep 5.
The shortage of deceased organs is still a serious issue in Japan. A proactive approach to using liver grafts from extended criteria donors (ECDs) may be one way of expanding the donor pool; however, if it is recklessly attempted, a recipient receiving such a marginal graft can be at risk of mortality due to primary non-function or delayed graft function. We herein report the successful outcome of a recipient receiving a severely cholestatic graft that was considered transplantable because it lacked features characteristic of a long duration of "cholestasis" according to the precise interpretation of a donor biopsy. Plasma exchange was intentionally introduced to prevent toxic insult by hyperbilirubinemia immediately after transplant. Despite transient acute kidney injury immediately after transplant, the patient's renal impairment was well managed with a renal-sparing immunosuppressive regimen consisting of basiliximab and mycophenolate mofetil. Although the use of liver grafts from ECDs still needs to be discussed, especially regarding graft selection and allocation policies, efforts not to discard valuable grafts should be undertaken in our country.
在日本，已故器官短缺仍是一个严重问题。积极采用扩大标准供体（ECD）的肝脏移植物可能是扩大供体库的一种方式；然而，如果贸然尝试，接受这种边缘性移植物的受者可能会因原发性无功能或移植功能延迟而面临死亡风险。我们在此报告一名接受严重胆汁淤积性移植物的受者的成功结果，根据对供体活检的精确解读，该移植物因缺乏长时间“胆汁淤积”的特征而被认为可移植。移植后立即有意进行血浆置换以防止高胆红素血症的毒性损伤。尽管移植后立即出现短暂性急性肾损伤，但通过由巴利昔单抗和霉酚酸酯组成的肾脏保护免疫抑制方案，患者的肾功能损害得到了良好控制。尽管使用ECD的肝脏移植物仍需讨论，特别是在移植物选择和分配政策方面，但我国应努力不丢弃有价值的移植物。
