Herrera L A, Castillo J, Martino E, Rabanal J M, Fleitas M G
Department of General Surgery, Hospital Universitario Marques de Valdecilla, Santander, Cantabria, Spain.
Transplantation. 1996 Jul 15;62(1):133-5. doi: 10.1097/00007890-199607150-00027.
The good results reported for liver transplantation have encouraged a much wider application of the procedure, broadening the list of indications and increasing the number of candidates. The shortage of organs for transplantation is a main problem that limits hepatic replacement in the potential recipients. Consequently, the number of contraindications for donor selection has been reduced over the last years. Some factors that were previously thought to preclude successful transplantation have now been relegated to relative contraindications, while others are no longer included. This has frequently led to the use of livers under suboptimal conditions or with anatomical anomalies. This is the case of donors with abdominal situs inversus. In this article, we report an orthotopic liver transplantation using a donor with abdominal situs inversus. Immunosuppressive protocol following surgery was composed of a classic three-drug therapy (cyclosporine, azathioprine, and prednisolone). The modified piggyback technique was performed over the right suprahepatic vein with orthotopic position of the graft. The graft showed good long-term function in the recipient, with a normal hepatic biopsy 5 months after the transplantation. There was no patient readmission or other medical problem after a 2 1/2-year follow-up.
肝移植所报告的良好效果促使该手术得到了更广泛的应用，扩大了适应证范围并增加了候选者数量。移植器官短缺是限制潜在受者进行肝脏置换的一个主要问题。因此，在过去几年中，供体选择的禁忌证数量有所减少。一些以前被认为会妨碍成功移植的因素现在已降为相对禁忌证，而其他一些因素则不再被列入禁忌证。这经常导致在次优条件下或存在解剖异常的情况下使用肝脏。腹部脏器反位的供体就是这种情况。在本文中，我们报告了一例使用腹部脏器反位供体的原位肝移植手术。术后的免疫抑制方案由经典的三联药物疗法（环孢素、硫唑嘌呤和泼尼松龙）组成。采用改良背驮式技术，在肝右静脉上方进行移植，移植肝处于原位。移植肝在受者体内显示出良好的长期功能，移植后5个月肝脏活检结果正常。经过2年半的随访，没有患者再次入院或出现其他医疗问题。
