Hirata Yuta, Sanada Yukihiro, Omameuda Takahiko, Katano Takumi, Miyahara Go, Yamada Naoya, Okada Noriki, Onishi Yasuharu, Sakuma Yasunaru, Sata Naohiro
Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan.
Surg Case Rep. 2020 Jul 3;6(1):159. doi: 10.1186/s40792-020-00920-y.
There have been no reports on the effectiveness of the administration of antithrombin III (AT III) for post-transplant portal vein thrombosis (PVT). We herein report a case of post-transplant PVT that was resolved by AT III treatment after living donor liver transplantation (LDLT).
The patient was a 57-year-old man who had been diagnosed with decompensate liver cirrhosis by hepatitis C virus infection. He presented with repeated hepatic coma and refractory ascites. Computed tomography (CT) revealed PVT of Yerdel classification grade II before LDLT. He underwent ABO-identical LDLT using a right lobe graft. A liver function test revealed elevated liver enzyme levels on post-operative day (POD) 14. The CT examination on POD 15 revealed PVT in the left side of the main portal vein at the side of left gastric vein ligation. AT III treatment from POD 15 to POD 24 was performed. Magnetic resonance imaging revealed that the PVT had decreased 10% on POD 27. Furthermore, AT III treatment from POD 28 to POD 32 was performed. The CT examination demonstrated the disappearance of PVT on POD 69 and thereafter, he had no recurrence of PVT on 10 post-operative month (POM).
The present case suggests that the administration of AT III is safe and suitable for the treatment of post-transplant PVT.
关于抗凝血酶III（AT III）治疗移植后门静脉血栓形成（PVT）的有效性尚无报道。我们在此报告一例活体肝移植（LDLT）后经AT III治疗得以缓解的移植后PVT病例。
患者为一名57岁男性，因丙型肝炎病毒感染被诊断为失代偿期肝硬化。他反复出现肝昏迷和难治性腹水。计算机断层扫描（CT）显示LDLT术前Yerdel分类II级的PVT。他接受了使用右叶移植物的ABO血型相同的LDLT。肝功能检查显示术后第14天肝酶水平升高。术后第15天的CT检查显示在胃左静脉结扎侧的主门静脉左侧有PVT。从术后第15天至第24天进行了AT III治疗。磁共振成像显示术后第27天PVT减少了10%。此外，从术后第28天至第32天进行了AT III治疗。CT检查显示术后第69天PVT消失，此后，术后10个月（POM）他未出现PVT复发。
本病例表明，AT III治疗移植后PVT安全且适用。
