Cao S, Cox K, So S S, Berquist W, Lee S P, Haigh W G, Concepcion W, Monge H, Esquivel C O
Department of Surgery, Stanford University Medical Center, Palo Alto, California 94304, USA.
Dig Dis Sci. 1997 Jul;42(7):1409-15. doi: 10.1023/a:1018894005748.
Recent advancements in liver transplantation have resulted in extended survival both for grafts and recipients. Such improvement, together with the shortage of donor organs has prompted expansion of the donor pool to include less than ideal donors, especially in life-threatening situations. The use of older liver donors has been associated with lower long-term survival. However, potential morbidity such as gallstone formation has not been explored. We analyzed bile composition in a child who developed cholesterol gallstones in the proximal bile duct two years after undergoing emergency liver transplantation with a liver from a 78-year-old donor. Oral administration of ursodeoxycholic acid (ursodiol) shifted the cholesterol composition of the bile from a supersaturated, potentially crystallized state to a liquid (micellar) state. Unlike cyclosporin A, FK506 showed an increase in the proportion of chenodeoxycholic acid and a decrease in the proportion of cholic acid, and thus may exhibit minimal or no hepatotoxic effect. Thus, in donor livers with factors known to be associated with cholesterol gallstone formation (such as age, sex, or obesity), one may consider analyzing the bile composition at the time of procurement. Depending on cholesterol and bile acid composition the use of FK506 with or without addition of ursodeoxycholic acid may be warranted.
肝移植领域的最新进展使移植物和受者的生存期均得以延长。这种改善，再加上供体器官短缺，促使扩大供体库以纳入不太理想的供体，尤其是在危及生命的情况下。使用年龄较大的肝脏供体与较低的长期生存率相关。然而，诸如胆结石形成等潜在的发病率尚未得到研究。我们分析了一名儿童的胆汁成分，该儿童在接受来自一名78岁供体的肝脏进行紧急肝移植两年后，在近端胆管形成了胆固醇结石。口服熊去氧胆酸（熊二醇）使胆汁中的胆固醇成分从过饱和的、可能结晶的状态转变为液体（胶束）状态。与环孢素A不同，他克莫司（FK506）显示鹅去氧胆酸比例增加，胆酸比例降低，因此可能表现出最小的肝毒性作用或无肝毒性作用。因此，对于已知与胆固醇结石形成相关因素（如年龄、性别或肥胖）的供体肝脏，在获取时可考虑分析胆汁成分。根据胆固醇和胆汁酸成分，可能有必要使用他克莫司，可添加或不添加熊去氧胆酸。
