Choudhary Narendra S, Saigal Sanjiv, Saraf Neeraj, Rastogi Amit, Goja Sanjay, Bhangui Prashant, Thiagrajan Srinivasan, Gautam Dheeraj, Govil Deepak, Vohra Vijay, Soin Arvinder S
Medanta Institute of Liver Transplantation and regenerative Medicine, Medanta, The Medicity, Gurgaon, India.
Department of Histopathology, Medanta, The Medicity, Gurgaon, India.
J Clin Exp Hepatol. 2018 Jun;8(2):132-135. doi: 10.1016/j.jceh.2017.11.003. Epub 2017 Nov 14.
Although liver transplantation is a definitive cure for Wilson's disease (WD), there is limited data about results of living donor liver transplantation (LDLT) in adults.
18 adults underwent LDLT for WD. The presentations before LDLT were decompensated cirrhosis ( = 16), acute on chronic liver failure ( = 1) and acute liver failure ( = 1). The donors were parents ( = 2), siblings ( = 3), cousin ( = 1), daughter ( = 1), nephew ( = 1), spouse or relatives of spouse ( = 9) and from swap transplantation ( = 1). All genetically related donors were negative for screening of WD.
The study cohort comprised of 15 males and 3 females, aged 32 ± 10 years. Severity of liver disease (excluding acute liver failure patient) was as follows; Child's score 10 ± 2, model for end-stage liver disease (MELD) score 18 ± 6. The graft to recipient weight ratio was 1 ± 0.2. The ICU and hospital stay were 5.5 ± 0.9 and 15 ± 5 days. Two patients died in first month after liver transplantation, rest of patients are doing well at median 15 (8-38 months). Two patients had acute cellular rejection that responded to steroids, one had hepatic artery thrombosis and 2 had biliary strictures. Three patients had neurological symptoms; 2 of these patients had partial recovery while one had complete recovery. There was no significant difference between LDLT from genetically related or unrelated donors.
LDLT for WD in adults is associated with good outcomes.
尽管肝移植是威尔逊病(WD)的根治方法,但关于成人活体肝移植(LDLT)结果的数据有限。
18名成人因WD接受了LDLT。LDLT前的表现为失代偿性肝硬化(n = 16)、慢性肝衰竭急性发作(n = 1)和急性肝衰竭(n = 1)。供体为父母(n = 2)、兄弟姐妹(n = 3)、堂兄弟姊妹(n = 1)、女儿(n = 1)、侄子(n = 1)、配偶或配偶的亲属(n = 9)以及来自交换移植(n = 1)。所有基因相关供体的WD筛查均为阴性。
研究队列包括15名男性和3名女性,年龄32±10岁。肝病严重程度(不包括急性肝衰竭患者)如下:Child评分10±2,终末期肝病模型(MELD)评分18±6。移植物与受体重量比为1±0.2。重症监护病房(ICU)和住院时间分别为5.5±0.9天和15±5天。两名患者在肝移植后第一个月死亡,其余患者在中位数15(8 - 38个月)时情况良好。两名患者发生急性细胞排斥反应,对类固醇治疗有反应,一名患者发生肝动脉血栓形成,两名患者发生胆管狭窄。三名患者有神经症状;其中两名患者部分恢复,一名患者完全恢复。基因相关或非相关供体的LDLT之间无显著差异。
成人WD的LDLT预后良好。