Department of General Surgery (Hepatopancreatobiliary Surgery Unit), Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi-Çapa-Şehremini, 34390, İstanbul, Turkey.
Department of Anesthesiology and Intensive Care, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
J Gastrointest Surg. 2021 Oct;25(10):2516-2523. doi: 10.1007/s11605-021-04932-3. Epub 2021 Feb 9.
Living donor liver transplantation may complement cadaveric transplantation in acute liver failure (ALF) patients.
Between 2008 and 2017, 89 patients were treated for ALF; 15 patients (17%) recovered with intensive care treatment; 31 (35%) died without transplant. The records of the remaining 43 patients (median (range) age: 14 (1-62)) who underwent transplantation were evaluated.
The etiologic factors were toxic agents (10; mushrooms: 8; herbs: 2), hepatitis viruses (7; A: 1; B: 6), Wilson's disease (7), autoimmune hepatitis (4), and Budd-Chiari syndrome (2); 13 cases were idiopathic. Cadaveric organs (whole, split, reduced) were transplanted to 32 patients; 11 patients underwent living donor transplantation. One patient (2%) died of septic shock on the second postoperative day. Bacterial infection was the most common early (< 3 months) complication in the remaining patients (31/42; 74%), followed by delirium (5/42; 12%) and acute rejection requiring steroid pulse (5/42; 12%). Seven other patients died during median (range) follow-up of 94 (14-142) months: various infections (5), leukemia (1), and acute myocardial infarction (1). The 1-, 5-, and 10-year survival rates were 100%, 96%, and 92% in children and 94%, 82%, and 65% in adults respectively.
Cadaveric organ sharing and transplantation from living donors when appropriate yield a high survival rate, despite high early morbidity, in ALF patients whose conditions deteriorate despite intensive care treatment. Efforts to eliminate preventable causes of acute liver failure will lead to more efficient use of health care resources.
活体供肝移植可在急性肝衰竭（ALF）患者中补充尸体供肝移植。
2008 年至 2017 年间，89 例 ALF 患者接受治疗；15 例（17%）经重症监护治疗后康复；31 例（35%）死亡未进行移植。评估了其余 43 例（中位数（范围）年龄：14（1-62））接受移植患者的记录。
病因包括毒剂（10 例；蘑菇：8 例；草药：2 例）、肝炎病毒（7 例；A 型：1 例；B 型：6 例）、Wilson 病（7 例）、自身免疫性肝炎（4 例）和 Budd-Chiari 综合征（2 例）；13 例为特发性。32 例患者接受了尸体器官（全肝、劈裂、减体积）移植；11 例患者接受了活体供者移植。1 例患者（2%）在术后第 2 天死于感染性休克。细菌感染是其余患者（31/42；74%）早期（<3 个月）最常见的并发症，其次是谵妄（5/42；12%）和需要类固醇冲击的急性排斥反应（5/42；12%）。在中位数（范围）94（14-142）个月的随访期间，另外 7 例患者死亡：各种感染（5 例）、白血病（1 例）和急性心肌梗死（1 例）。儿童患者的 1、5 和 10 年生存率分别为 100%、96%和 92%，成人患者分别为 94%、82%和 65%。
尽管经重症监护治疗后病情恶化的 ALF 患者早期发病率较高，但通过尸体器官共享和适当的活体供肝移植，仍可获得较高的生存率。努力消除急性肝衰竭的可预防病因将导致更有效地利用医疗保健资源。
