Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan; Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, Tochigi Cancer Center, Tochigi, Japan.
Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
Transplant Proc. 2024 Jan-Feb;56(1):239-243. doi: 10.1016/j.transproceed.2023.11.031. Epub 2024 Jan 12.
Liver transplantation (LT) is the only life-saving option when acute-on-chronic liver failure (ACLF) does not improve with conservative therapy. Acute pancreatitis (AP) can cause chronic liver disease progression to ACLF. However, deceased donor LT for patients with AP has had mixed results, and no consensus has been established regarding the indication for LT. We report the first successful living donor LT (LDLT) for ACLF caused by severe AP. The 38-year-old patient with alcoholic liver disease was transferred to our institute with worsening refractory ascites. During the pretransplant workup, she developed severe acute necrotizing pancreatitis, resulting in grade 3 ACLF. The patient's clinical course was further complicated by high levels of donor-specific antibodies and immune thrombocytopenia. The AP gradually improved after intensive care combined with artificial liver support. The patient successfully underwent urgent LDLT with upfront splenectomy and desensitization therapy, including plasm exchange, high-dose intravenous immunoglobulin, and anti-thymocyte globulin. No infection or recurrence of AP was observed postoperatively. We conclude that LDLT is a feasible option for ACLF patients caused by severe AP if a deceased donor is not readily available.
肝移植（LT）是急性慢性肝衰竭（ACLF）在保守治疗下没有改善时唯一的救命选择。急性胰腺炎（AP）可导致慢性肝病进展为 ACLF。然而，对于患有 AP 的患者，进行尸体供体 LT 的效果不一，并且对于 LT 的适应证尚未达成共识。我们报告了首例由严重 AP 引起的 ACLF 的成功活体供体 LT（LDLT）。这位 38 岁的酒精性肝病患者因难治性腹水加重转入我院。在移植前检查期间，她发生了严重的急性坏死性胰腺炎，导致 3 级 ACLF。患者的临床病程进一步因供体特异性抗体和免疫性血小板减少症水平升高而复杂化。经过强化护理和人工肝支持治疗，AP 逐渐改善。患者成功接受了紧急 LDLT，包括脾切除术和脱敏治疗，包括血浆置换、大剂量静脉注射免疫球蛋白和抗胸腺细胞球蛋白。术后未观察到感染或 AP 复发。我们的结论是，如果无法获得已故供体，LDLT 是由严重 AP 引起的 ACLF 患者的可行选择。
