Living related liver transplantation for acute fulminant hepatitis B: experience from two possible hyper-acute cases.
Living related liver transplantation for acute fulminant hepatitis B: experience from two possible hyper-acute cases.
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活体相关肝移植治疗急性暴发性乙型肝炎：来自两个可能的超急性病例的经验。
DOI：
10.1620/tjem.205.197
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发表时间：
2005
期刊：
影响因子：
--
通讯作者：
T. Shimosegawa
中科院分区：
文献类型：
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作者：
J. Inoue;Y. Ueno;N. Kanno;H. Anzai;Y. Kondo;Y. Moritoki;Emiko Mikami;Masanori Chiba;T. Kogure;F. Nagasaki;K. Fukushima;T. Iwasaki;S. Satomi;T. Shimosegawa
暴发性肝衰竭，以暴发性肝炎为代表，在大多数情况下是致命的，除非及时进行肝移植。即使进行肝移植，不可逆转的神经损伤也常常是复杂的。在这个病例报告中，我们描述了两例由急性乙型肝炎病毒感染引起的暴发性肝炎，这两例患者都成功地通过活体肝移植获救，没有明显的并发症。病例1为一名45岁的日本男性。他抱怨全身不适和厌食。当地医生诊断为急性乙型肝炎，转介到我院。因凝血功能严重，行血浆置换3次。但肝性昏迷进展迅速，直接/间接胆红素（D/T）比和血清尿素氮（BUN）水平均迅速下降。病例2为日本男性，34岁，诊断为急性乙型肝炎，行活体亲属肝移植。他的病是发烧和皮肤发红。患者以急性乙型肝炎转诊至我院，入院后第2天出现肝性II级昏迷，经血浆置换等强化治疗后病情恶化为III级。他还发现D/T比和血清BUN水平迅速下降。次日行活体相关肝移植。两例均痊愈，无任何神经系统后遗症。一般来说，通过保守治疗来挽救暴发性肝炎是极其困难的，特别是在病情迅速发展的情况下。虽然紧急肝移植可能是这种情况下唯一的抢救选择，但鉴于紧急器官捐赠，活体相关肝移植比尸体移植具有优势。
Fulminant hepatic failure, which is represented by fulminant hepatitis, is fatal in most cases unless prompt liver transplantation is performed. Even if liver transplantation is performed, irreversible neurological damage is often complicated. In this case report, we describe two cases of fulminant hepatitis induced by acute hepatitis B virus infection, both of which were successfully rescued by living related liver transplantation without significant complications. The case 1 was a 45-year-old Japanese male. He complained general malaise and anorexia. His local physician diagnosed him as acute hepatitis B, and referred to our hospital. Due to severe coagulopathy, plasma exchange was performed 3 times. However, his hepatic coma progressed rapidly along with rapid decrease of both his direct/indirect bilirubin (D/T) ratio and serum blood urea nitrogen (BUN) levels. Living related liver transplantation was performed under the diagnosis of acute fulminant hepatitis B. The case 2 was a 34-year-old Japanese male. His complaints were fever and skin rush. He was referred to our hospital under the diagnosis of acute hepatitis B. On the second day after admission, he developed grade II hepatic coma, which deteriorated into grade III in spite of intensive therapy including plasma exchange. He also demonstrated rapid decrease of both D/T ratio and serum BUN level. Living related liver transplantation was performed on the next day. Both cases recovered without any evidence of neurological sequelae. In general, it is extremely difficult to rescue fulminant hepatitis by conservative treatments, particularly in cases with rapid progression. Although emergency liver transplantation may be an only option to rescue in such a case, living related liver transplantation has an advantage in view of urgent organ donation over cadeveric transplantation.