Hammer G B, So S K, Al-Uzri A, Conley S B, Concepcion W, Cox K L, Berquist W E, Esquivel C O
Department of Anesthesiology, Stanford University Medical Center, California 94305, USA.
Transplantation. 1996 Jul 15;62(1):130-2. doi: 10.1097/00007890-199607150-00026.
Children who experience acute liver failure following liver transplantation will have multiple organ failure and a high rate of mortality unless emergency retransplantation can be performed. Transplant hepatectomy with portocaval shunting has been described as a bridge to transplantation in the most severe cases, as well as in patients with fulminant hepatic failure at high risk for mortality who have not undergone liver transplantation. Patients with multiple organ failure who have undergone hepatectomy require renal replacement therapy. Continuous hemofiltration may be used in patients with fulminant hepatic failure to facilitate fluid removal and circulatory and metabolic balance. We used continuous venovenous hemofiltration with dialysis following hepatectomy with portocaval shunting in a patient who remained anhepatic for 66 hr in order to achieve circulatory and metabolic homeostasis as well as stable neurologic function prior to successful retransplantation.
肝移植后发生急性肝衰竭的儿童会出现多器官功能衰竭，死亡率很高，除非能进行紧急再次移植。在最严重的病例以及未接受肝移植但死亡率高的暴发性肝衰竭患者中，移植性肝切除术联合门腔分流术已被描述为移植的桥梁。接受肝切除术的多器官功能衰竭患者需要肾脏替代治疗。连续性血液滤过可用于暴发性肝衰竭患者，以促进液体清除及维持循环和代谢平衡。我们对一名在肝切除联合门腔分流术后无肝期长达66小时的患者采用了连续性静脉-静脉血液滤过联合透析，以便在成功再次移植前实现循环和代谢稳态以及稳定的神经功能。
