肝移植受者复发性肝性脑病的自发性门体分流栓塞术
Spontaneous portosystemic shunt embolization in liver transplant recipients with recurrent hepatic encephalopathy.
作者信息
Álvarez-López Patricia, Campos-Varela Isabel, Quiroga Sergi, Díez Iratxe, Charco Ramón, Simón-Talero Macarena, Castells Lluís
机构信息
Liver Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.
Liver Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
出版信息
Ann Hepatol. 2022 May-Jun;27(3):100687. doi: 10.1016/j.aohep.2022.100687. Epub 2022 Feb 19.
INTRODUCTION AND OBJECTIVES
Spontaneous portosystemic shunts (SPSS) are a common cause of recurrent hepatic encephalopathy (HE). Shunt occlusion is an effective and safe procedure when performed in patients with cirrhosis and preserved liver function. We aimed to describe our experience with SPSS embolization after liver transplantation (LT).
PATIENTS
We identified five patients who underwent SPSS embolization after LT. Clinical, biochemical and technical procedure data were collected.
RESULTS
At presentation, all patients had developed graft cirrhosis and HE after LT. Median Model for End-stage Liver Disease (MELD) at embolization was 9 (range 7-12), median Child-Pugh was 8 (range 7-9). Splenorenal and mesocaval shunt were the most frequent types of SPSS found. Three patients have been completely free of HE. Of the two patients who had HE recurrence after embolization, one patient had two episodes of HE which was controlled well with medications. The other patient required three embolizations because of recurrent HE. Median follow-up was 4.4 years (range 1.0-5.0) and MELD score at last follow up was 13 (range 10-18) and median Child-Pugh score B, 7 points (range 5-12).
CONCLUSIONS
SPSS can be considered as a cause of HE after LT. SPSS embolization is feasible and safe in LT recipients.
引言与目的
自发性门体分流（SPSS）是肝性脑病（HE）复发的常见原因。对于肝功能保留的肝硬化患者，分流闭塞是一种有效且安全的手术。我们旨在描述肝移植（LT）后SPSS栓塞的经验。
患者
我们确定了5例LT后接受SPSS栓塞的患者。收集了临床、生化和技术操作数据。
结果
就诊时，所有患者LT后均发生移植物肝硬化和HE。栓塞时终末期肝病模型（MELD）中位数为9（范围7 - 12），Child-Pugh中位数为8（范围7 - 9）。脾肾分流和肠系膜上腔静脉分流是最常见的SPSS类型。3例患者完全没有发生HE。在栓塞后HE复发的2例患者中，1例患者发生了2次HE发作，通过药物得到了很好的控制。另1例患者因HE复发需要进行3次栓塞。中位随访时间为4.4年（范围1.0 - 5.0），最后一次随访时MELD评分为13（范围10 - 18），Child-Pugh评分中位数为B级，7分（范围5 - 12）。
结论
SPSS可被视为LT后HE的一个原因。SPSS栓塞在LT受者中是可行且安全的。
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