Yan Liting, Qian Chao, Duan Xin, Ding Jun, Zhang Wei
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, China.
Medicine (Baltimore). 2020 Oct 23;99(43):e22934. doi: 10.1097/MD.0000000000022934.
Liver transplantation (LT) is the only final therapy for patients with acute liver failure (ALF) that cannot be controlled by conservative treatment. Acute pancreatitis (AP) is a recognized complication of ALF. The pathogenesis of AP in ALF patients has not yet been elucidated. The appearance of AP complicates the patients condition and causes a significantly increased risk of mortality.
We report 2 fatal cases who were both admitted with yellowing of skin and sclera with general weakness lasting for 2 weeks.
After admission, the laboratory examination of case 1 showed liver dysfunction with serum levels of total bilirubin (TB) 270 μmol/l, alanine aminotransferase (ALT) 106 U/l. Abdominal computed tomography (CT) showed pelvic and peritoneal cavity fluids, occupation of left lateral lobe of liver and unclear margin of pancreas. The clinical laboratory findings of case 2 revealed TB 351.1 μmol/l, ALT 252 U/l, blood lactic acid 18 mmol/l, ammonia 209 μmol/l. And abdominal CT showed pancreatic exudation. They were both diagnosed with acute liver failure, hepatic encephalopathy and AP which was confirmed during the operation.
They were both received a routine orthotopic LT.
After the surgery, their liver functions recovered well, and they received conventional conservative treatment for pancreatitis. However, the treatment was not adequately effective, and the infection was too serious and both died of multiple organ failure despite emergency rescue efforts on day 21 and day 19 after LT.
AP is a serious complication that can contribute to prohibitive morbidity and mortality in LT patients. For this reason, the vulnerable state of the pancreas and the scoring system must be defined to help clinicians decide whether a patient is suitable for liver transplantation, and the clinical experience in the treatment of pancreatitis after LT needs to be summarized as an optimal treatment guideline to facilitate better treatment.
肝移植（LT）是急性肝衰竭（ALF）患者经保守治疗无法控制时的唯一最终治疗方法。急性胰腺炎（AP）是ALF公认的并发症。ALF患者中AP的发病机制尚未阐明。AP的出现使患者病情复杂化，并导致死亡率显著增加。
我们报告2例致命病例，均因皮肤和巩膜黄染、全身乏力入院，症状持续2周。
入院后，病例1的实验室检查显示肝功能不全，血清总胆红素（TB）水平为270μmol/L，丙氨酸氨基转移酶（ALT）为106U/L。腹部计算机断层扫描（CT）显示盆腔和腹腔积液，肝左外叶占位，胰腺边缘不清。病例2的临床实验室检查结果显示TB为351.1μmol/L，ALT为252U/L，血乳酸为18mmol/L，氨为209μmol/L。腹部CT显示胰腺渗出。二者均被诊断为急性肝衰竭、肝性脑病和AP，术中得以证实。
二者均接受了常规原位肝移植。
术后，他们的肝功能恢复良好，并接受了胰腺炎的常规保守治疗。然而，治疗效果不佳，感染严重，尽管在肝移植术后第21天和第19天进行了紧急抢救，二者均死于多器官功能衰竭。
AP是一种严重的并发症，可导致肝移植患者出现极高的发病率和死亡率。因此，必须明确胰腺的脆弱状态和评分系统，以帮助临床医生判断患者是否适合肝移植，并且需要总结肝移植术后胰腺炎的临床治疗经验，形成最佳治疗指南，以促进更好的治疗。
