Kano Takeshi, Takahashi Ryugen, Akamatsu Nobuhisa, Nishioka Yujiro, Mihara Yuichiro, Ichida Akihiko, Takamoto Takeshi, Kawaguchi Yoshikuni, Hasegawa Kiyoshi
Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0264. Epub 2025 Sep 6.
Steatotic liver disease (SLD) may develop in some patients after pancreaticoduodenectomy (PD), but no cases requiring liver transplantation (LT) have been reported to date. Here, we present two cases in which LT was performed for decompensated liver cirrhosis (LC) after PD.
Case 1 was a 53-year-old man with obesity, metabolic-associated SLD (MASLD), and diabetes mellitus. The patient underwent PD for an intraductal papillary mucinous neoplasm. His liver function worsened and he developed decompensated LC 6 years later, eventually requiring LT. Due to poor mobility of the jejunal limb caused by severe adhesions and the presence of a pancreatojejunostomy, a choledochojejunostomy was performed at the more distal site of the common bile duct than usual. He developed hemobilia and biliary leakage but was discharged on POD 107. Liver function has been good for 2 years after LT without MASLD recurrence, although endoscopic treatment is periodically required for biliary stricture. Case 2 was a 46-year-old man with obesity, SLD, and a history of excessive alcohol consumption. The patient underwent PD for duodenal cancer. Five years later, he developed decompensated LC, which required living-donor LT. For biliary reconstruction, a new jejunal limb was created and elevated. He was discharged on POD 79. He has repeatedly developed cholangitis, but his liver function has been good for 6 years without SLD recurrence.
Steatohepatitis can worsen following PD and may lead to decompensated LC, ultimately requiring LT. Therefore, screening for steatohepatitis and its risk factors prior to PD is essential, and prophylaxis should be considered. LT after PD presents surgical challenges and biliary reconstruction with some procedural modifications.
部分患者在胰十二指肠切除术（PD）后可能会发生脂肪性肝病（SLD），但迄今为止尚未有需要肝移植（LT）的病例报道。在此，我们报告两例在PD后因失代偿期肝硬化（LC）而接受LT的病例。
病例1是一名53岁男性，患有肥胖症、代谢相关脂肪性肝病（MASLD）和糖尿病。该患者因导管内乳头状黏液性肿瘤接受了PD。6年后，他的肝功能恶化，发展为失代偿期LC，最终需要进行LT。由于严重粘连导致空肠袢活动度差以及存在胰空肠吻合口，在胆总管比通常更远端的部位进行了胆总管空肠吻合术。他出现了胆道出血和胆漏，但在术后第107天出院。LT后2年肝功能良好，MASLD未复发，尽管胆道狭窄需要定期进行内镜治疗。病例2是一名患有肥胖症、SLD且有过量饮酒史的46岁男性。该患者因十二指肠癌接受了PD。5年后，他发展为失代偿期LC，需要进行活体供肝LT。为了进行胆道重建，创建并提升了一个新的空肠袢。他在术后第79天出院。他反复发生胆管炎，但6年来肝功能良好，SLD未复发。
PD后脂肪性肝炎可能会恶化，并可能导致失代偿期LC，最终需要进行LT。因此，在PD前筛查脂肪性肝炎及其危险因素至关重要，应考虑进行预防。PD后的LT存在手术挑战，并且胆道重建需要一些程序上的修改。
