Yesmembetov Kakharman, Sultanaliyev Tokan, Mukazhanov Adilbek, Zhexembayev Assan, Kuttymuratov Gani, Spatayev Zhanat, Mussin Yevgeniy, Umbetzhanov Yerlan, Orazbayeva Damesh
From the Department of Hepatology, National Scientific Center for Oncology and Transplantology, Astana, Kazakhstan; and the of Hepatology, Gastroenterology, and Nutrition, Astana, Kazakhstan.
Exp Clin Transplant. 2018 Mar;16 Suppl 1(Suppl 1):152-153. doi: 10.6002/ect.TOND-TDTD2017.P42.
Liver transplant is the only treatment option for patients with end-stage liver disease.
Liver transplant procedures performed from June 2013 to March 2017 were evaluated. We evaluated the postoperative period in recipients of livers from deceased and living donors.
Of 31 liver transplant procedures in 30 recipients, 12 were from deceased and 19 from living donors. The final analysis included 24 liver transplants (11 males, 13 females), with 10 from deceased and 14 from living donors. No deaths or life-threatening and debilitating complications were shown in liver donors. All living-donor liver transplants were performed utilizing the right lobe, the volume of which was calculated using contrast-enhanced computed tomography. Most living-donor liver recipients had viral hepatitis, whereas most deceased-donor liver recipients had autoimmune liver disease. Median age of recipients of deceased donations was 39.3 years (median admission duration of 28.1 days), and median age of recipients of donations from living donors was 45.4 years (median admission duration of 36.4 days). All patients were started on an immunosuppression protocol, which included basiliximab on days 0 and 4, tacrolimus, mycophenolate, and prednisolone. Of 24 recipients, 5 were taking prednisolone 10 mg/day or less at discharge.
Most of our liver transplant procedures were living-donor liver transplants (61.3%). Most patients who received living donations had viral hepatitis, with all cases related to autoimmune liver disease receiving deceased donations. This may be related to the possibility of antiviral therapy controlling all stages of liver disease versus no chance of controlling autoimmune liver disease. Living-donor liver transplant recipients required more time to recover to reach initial liver volume; 20.8% of recipients were discharged with prednisolone of 10 mg/day or less. Our results suggest a need for further development of nonsteroidal immunosuppression strategies to minimize infections and steroid-related adverse effects.
肝移植是终末期肝病患者唯一的治疗选择。
对2013年6月至2017年3月期间进行的肝移植手术进行评估。我们评估了来自已故供体和活体供体肝脏受者的术后情况。
30名受者接受了31例肝移植手术，其中12例来自已故供体，19例来自活体供体。最终分析纳入24例肝移植（11例男性，13例女性），其中10例来自已故供体，14例来自活体供体。肝供体未出现死亡或危及生命及使人衰弱的并发症。所有活体供肝移植均采用右叶，其体积通过增强CT计算得出。大多数活体供肝受者患有病毒性肝炎，而大多数已故供肝受者患有自身免疫性肝病。已故供体肝脏受者的中位年龄为39.3岁（中位住院时间为28.1天），活体供体肝脏受者的中位年龄为45.4岁（中位住院时间为36.4天）。所有患者均开始采用免疫抑制方案，包括在第0天和第4天使用巴利昔单抗、他克莫司、霉酚酸酯和泼尼松龙。24例受者中，5例在出院时服用泼尼松龙剂量为每日10毫克或更低。
我们的大多数肝移植手术为活体供肝移植（61.3%）。大多数接受活体供肝的患者患有病毒性肝炎，所有自身免疫性肝病患者均接受已故供肝。这可能与抗病毒治疗能够控制肝病各阶段，而无法控制自身免疫性肝病有关。活体供肝移植受者恢复到初始肝脏体积所需时间更长；20.8%的受者出院时服用泼尼松龙剂量为每日10毫克或更低。我们的结果表明需要进一步开发非甾体类免疫抑制策略，以尽量减少感染和类固醇相关不良反应。
