Living donor liver transplantation for acute liver failure: A 10-year experience in a single center
Living donor liver transplantation for acute liver failure: A 10-year experience in a single center
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DOI：
10.1016/j.jamcollsurg.2007.08.018
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发表时间：
2008-03-01
影响因子：
5.2
通讯作者：
Maehara, Yoshihiko
中科院分区：
文献类型：
--
作者：
Ikegami, Toru;Taketomi, Akinobu;Maehara, Yoshihiko
背景技术背景：活体肝移植已成为各种终末期肝病的公认治疗方法。研究设计：回顾了九州大学医院10年期间为急性肝功能衰竭进行的42例活体肝移植。结果：肝衰竭的原因包括B型肝炎（n=12）、丙型肝炎（n=1）、自身免疫性肝炎（n=2）、威尔逊病（n=3）和未知原因（n=24）。移植物类型为：左叶（n=33）、右叶（n=8）和外侧段（n=1）。左叶移植物的平均移植物体积与标准肝脏体积的比值为42.2 ± 9.2%，右叶移植物为50.5 ± 3.9%（p < 0.05）。IV级脑病患者的拔管时间（73.7 +/- 18.2小时）明显延迟于其他级别的患者（I级和II级p < 0.01，III级p < 0.05）。除1例蛛网膜下腔出血外，所有其他患者在移植后均完全恢复神经功能。1年和10年生存率分别为77.6%和65.5%，分别为移植物，和80.0%和68.2%，分别为patient.CONCLUSIONS：结果活体肝移植急性肝功能衰竭是相当可以接受的，尽管严重的一般条件和紧急移植设置。活体肝移植是目前公认的急性肝功能衰竭的首选挽救生命的治疗方法之一，尽管这种疾病的创新医学治疗方法仍在期待中。
BACKGROUND: Living donor liver transplantation has become an accepted treatment for various terminal liver diseases.STUDY DESIGN: Forty-two living donor liver transplantations performed for acute liver failure during a 10-year period at Kyushu University Hospital were reviewed.RESULTS: Causes of liver failure included hepatitis B (n=12), hepatitis C (n=1), autoimmune hepatitis (n=2), Wilson's disease (n=3), and unknown causes (n=24). The graft types were: left lobe (n=33), right lobe (n=8), and lateral segment (n=1). The mean graft volume to standard liver volume ratios were 42.2 +/- 9.2% in left lobe grafts and 50.5 +/- 3.9% in right lobe grafts (p < 0.05). Extubation was significantly delayed in grade IV encephalopathy patients (73.7 +/- 18.2 hours) compared with patients with other grades (p < 0.01 to grades I and II, p < 0.05 to grade III). All other patients, except one with a subarachnoid hemorrhage, had complete neurologic recovery after transplantation. The 1- and 10-year survival rates were 77.6% and 65.5%, respectively, for grafts, and 80.0% and 68.2%, respectively, for patients.CONCLUSIONS: Outcomes of living donor liver transplantation for acute liver failure are fairly acceptable despite severe general conditions and emergent transplant settings. Living donor liver transplantation is now among the currently accepted life-saving treatments of choice for acute liver failure, although innovative medical treatments for this disease entity are still anticipated.