Department of Hepatobiliary and Pancreatic Surgery, Department of Liver Transplantation, Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou, China.
Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China.
Transplant Proc. 2021 May;53(4):1303-1307. doi: 10.1016/j.transproceed.2021.02.008. Epub 2021 Mar 26.
Liver transplantation (LT) for acute-on-chronic liver failure (ACLF) accompanied by acute necrotizing pancreatitis is still unclear. We have a reported case of LT for ACLF associated with acute necrotizing pancreatitis. The postoperative multiorgan dysfunction and secondary infection were successfully managed under close supervision. The patient was a 47-year-old man with chronic hepatitis B virus infection presented with ACLF and acute necrotizing pancreatitis. After receiving LT from a deceased donor, the patient's liver functioning rapidly reverted to a normal level, and the acute pancreatitis was simultaneously stabilized. However, the patient later developed multiorgan dysfunction secondary to multidrug resistant bacteria infection, which was treated successfully with repeated percutaneous drainage, sensitive antibiotics, continuous renal replacement therapy, microbial balance, and best supportive care. LT can be considered for ACLF associated with acute necrotic pancreatitis without absolute contraindication. Moreover, we recommend a close observation of possible postoperative severe infection, and cautious multidisciplinary management was needed for the prevention of organ dysfunction.
肝移植（LT）治疗伴有急性坏死性胰腺炎的慢加急性肝衰竭（ACLF）仍存在争议。我们报告了 1 例 LT 治疗 ACLF 合并急性坏死性胰腺炎的病例。术后多器官功能障碍和继发感染在密切监护下得到成功治疗。患者为 47 岁男性，因慢性乙型肝炎病毒感染导致 ACLF 和急性坏死性胰腺炎。从已故供体接受 LT 后，患者的肝功能迅速恢复正常，急性胰腺炎同时得到稳定。然而，患者后来因多重耐药菌感染继发多器官功能障碍，经多次经皮引流、敏感抗生素、持续肾脏替代治疗、微生物平衡和最佳支持治疗成功治疗。对于无绝对禁忌证的 ACLF 合并急性坏死性胰腺炎可考虑 LT。此外，我们建议密切观察可能发生的术后严重感染，并需要谨慎的多学科管理以预防器官功能障碍。
