活体肝移植后尽管移植肝功能良好但仍因侵袭性曲霉病导致急性死亡：一例报告

Acute death caused by invasive aspergillosis after living-donor liver transplantation despite good graft function: a case report.

作者信息

Tomiyama Takahiro, Motomura Takashi, Iseda Norifumi, Morinaga Akinari, Shimagaki Tomonari, Kurihara Takeshi, Wang Huanlin, Toshima Takeo, Nagao Yoshihiro, Itoh Shinji, Harada Noboru, Yoshizumi Tomoharu, Mori Masaki

机构信息

Department of Surgery and Sciences, Graduate School of Medical Sciences, Kyushu University Hospital, Kyushu University, 3 Chome-1-1 Maidashi, Higashiku, Fukuoka, Fukuoka, 812-8582, Japan.

出版信息

Surg Case Rep. 2021 May 12;7(1):118. doi: 10.1186/s40792-021-01203-w.

DOI:10.1186/s40792-021-01203-w

PMID:33978845

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8116460/

Abstract

BACKGROUND

Invasive aspergillosis (IA) is one of the most serious causes of death after liver transplantation (LT). IA is the second most common fungal infection, and its mortality rate exceeds 80%.

CASE PRESENTATION

A 67-year-old man presented to our hospital because of fulminant hepatitis caused by hepatitis B virus. Candidiasis was detected in his sputum, and micafungin had already been administered. Living-donor LT was performed using a right lobe graft donated from his daughter with no intraoperative complications. Although he appeared to have good graft function, his oxygenation was inadequate, and a chest radiograph showed many invasive shadows on postoperative day 1. A computed tomography scan also showed many invasive shadows with the halo sign. A blood examination revealed positivity for Aspergillus antigen, and Aspergillus species were detected in his sputum. IA was diagnosed. The antifungal therapy was soon modified to amphotericin B combined with caspofungin. Despite good graft blood flow through the portal vein and hepatic artery and good graft function, the patient died of IA on postoperative day 3. The median time from LT to IA among reports published to date ranges from 18 to 25 days.

CONCLUSIONS

The present report describes the first case of very early onset of IA after LT.

摘要

背景

侵袭性曲霉病（IA）是肝移植（LT）后最严重的死亡原因之一。IA是第二常见的真菌感染，其死亡率超过80%。

病例介绍

一名67岁男性因乙型肝炎病毒引起的暴发性肝炎入住我院。在他的痰液中检测到念珠菌，并且已经给予了米卡芬净。使用其女儿捐献的右叶移植物进行了活体供肝肝移植，术中无并发症。尽管他的移植物功能似乎良好，但他的氧合不足，术后第1天胸部X线片显示有许多浸润影。计算机断层扫描也显示有许多伴有晕轮征的浸润影。血液检查显示曲霉抗原阳性，并且在他的痰液中检测到曲霉菌种。诊断为IA。抗真菌治疗很快改为两性霉素B联合卡泊芬净。尽管通过门静脉和肝动脉的移植物血流良好且移植物功能良好，但患者在术后第3天死于IA。迄今为止发表的报告中，从肝移植到IA的中位时间为18至25天。