暴发性乙型肝炎的临时异位辅助肝移植

Temporary heterotopic auxiliary liver transplantation for fulminant hepatitis B.

作者信息

van Hoek B, Ringers J, Kroes A C, van Krieken J H, van Schelven W D, Masclee A A, van Krikken-Hogenberk L G, Haak H R, Lamers C B, Terpstra O T

机构信息

Department of Gastroenterology and Hepatology, Diaconess Hospital Eindhoven, The Netherlands.

出版信息

J Hepatol. 1995 Aug;23(2):109-18. doi: 10.1016/0168-8278(95)80323-8.

DOI:10.1016/0168-8278(95)80323-8

PMID:7499780

Abstract

BACKGROUND/AIMS: Orthotopic liver transplantation has been shown to improve survival in fulminant hepatic failure. However, after orthotopic liver transplantation life-long immunosuppression is necessary and graft complications may occur.

METHODS

We employed heterotopic auxiliary liver transplantation in a 26-year-old man with fulminant hepatic failure due to hepatitis B virus infection.

RESULTS

From a comatose state with seizures and decerebrate posturing, the patient woke up the day after heterotopic auxiliary liver transplantation. The graft functioned sufficiently. After 2 weeks, when peritonitis developed, immunosuppression was stopped since the native liver was recovering as shown by serial HIDA scans, liver biopsies, clotting parameters and serum bilirubin. When severe rejection of the graft developed 2 weeks later, and the peritonitis had been treated successfully, the native liver had recovered sufficiently to allow the graft to be removed. Now, more than 1 year after heterotopic auxiliary liver transplantation, the patient is free from medication and he is immune for hepatitis B virus, his liver tests have returned to normal and he has regained his normal life.

CONCLUSIONS

Temporary heterotopic auxiliary liver transplantation for fulminant hepatitis B is feasible.

摘要

背景/目的：原位肝移植已被证明可提高暴发性肝衰竭患者的生存率。然而，原位肝移植后需要终身免疫抑制，且可能发生移植物并发症。

方法

我们对一名因乙型肝炎病毒感染导致暴发性肝衰竭的26岁男性实施了异位辅助肝移植。

结果

患者从伴有癫痫发作和去大脑强直姿势的昏迷状态中，在异位辅助肝移植术后第二天醒来。移植物功能良好。2周后发生腹膜炎，由于连续的肝胆动态显像扫描、肝活检、凝血参数和血清胆红素显示自体肝正在恢复，因此停止了免疫抑制。2周后移植物发生严重排斥反应，且腹膜炎已成功治疗，此时自体肝已充分恢复，从而可以切除移植物。现在，异位辅助肝移植术后1年多，患者无需服药，对乙型肝炎病毒具有免疫力，肝功能检查恢复正常，已恢复正常生活。