Kurata Nobuhiko, Shizuku Masato, Jobara Kanta, Ishizu Yoji, Ishigami Masatoshi, Ogura Yasuhiro
Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Aichi, Japan.
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Case Rep Transplant. 2023 Mar 16;2023:9075184. doi: 10.1155/2023/9075184. eCollection 2023.
Recently, magnetic resonance imaging (MRI) has been developed as a widely available and noninvasive method for detecting and evaluating hepatic iron overload. This case report presents a successful living donor liver transplantation (LDLT) in which the donor was suspected to have hepatic iron deposition by MRI evaluation. A preoperative donor liver biopsy and genetic examination were performed to exclude hereditary hemochromatosis and other chronic liver diseases. A liver biopsy showed an almost normal liver specimen with a slight deposition of iron in 2-3% of hepatocytes, and a genetic examination of hereditary hemochromatosis revealed no typical mutations in HFE, TFR2, HJV, HAMP, or SLC40A1. Despite the traumatic hemothorax complication caused by the liver biopsy, the liver transplant eligibility was confirmed. Two months after the hemothorax complication, an LDLT donor operation was performed. The donor was discharged from the hospital on postoperative day (POD) #17 with favorable liver function. The recipient's posttransplant clinical course was generally favorable except for acute cellular rejection and biliary complications, and the recipient was discharged from the hospital on POD #87 with excellent graft function. A one-year follow-up liver biopsy of the recipient demonstrated almost normal liver with iron deposition in less than 1% of the hepatocytes, and no iron deposition was identified in the liver graft by MRI examination. Liver biopsy and genetic examination are effective methods to evaluate the eligibility of liver transplant donors with suspected hepatic iron deposition. The living donor with slight hepatic iron deposition, if hereditary hemochromatosis was ruled out, can donate partial liver safely.
最近，磁共振成像（MRI）已发展成为一种广泛可用的非侵入性方法，用于检测和评估肝铁过载。本病例报告展示了一例成功的活体肝移植（LDLT），其中通过MRI评估怀疑供体存在肝铁沉积。进行了术前供体肝活检和基因检测，以排除遗传性血色素沉着症和其他慢性肝病。肝活检显示肝脏标本几乎正常，2 - 3%的肝细胞中有轻微铁沉积，遗传性血色素沉着症的基因检测显示HFE、TFR2、HJV、HAMP或SLC40A1中无典型突变。尽管肝活检导致了创伤性血胸并发症，但仍确认了该供体符合肝移植条件。血胸并发症发生两个月后，进行了LDLT供体手术。供体在术后第17天出院，肝功能良好。受体移植后的临床过程总体良好，除了急性细胞排斥反应和胆道并发症，受体在术后第87天出院，移植肝功能良好。对受体进行的一年随访肝活检显示肝脏几乎正常，不到1%的肝细胞中有铁沉积，MRI检查未在肝移植中发现铁沉积。肝活检和基因检测是评估疑似肝铁沉积的肝移植供体资格的有效方法。轻度肝铁沉积的活体供体，若排除遗传性血色素沉着症，可安全地捐献部分肝脏。
