成人间活体扩大右半肝移植治疗急性肝功能衰竭

Adult-to-adult living donor liver transplantation in treating acute fiver failure using extended right lobe graft

目的介绍成人间活体扩大右半肝移植治疗急性肝功能衰竭的临床经验。方法对1例42岁男性急性肝功能衰竭合并肝性脑病Ⅲ期患者行活体扩大右半肝移植治疗。其45岁姐姐为供者,CT 评估供者包含肝中静脉的扩大右半肝体积为728.4 cm^3(801 g),供肝/受者体重比为1.3%。供肝之肝右、中静脉整形后与受者整形后之肝右静脉行端-侧吻合;供受者门静脉、肝动脉行端-端吻合。供肝胆管整形后与受者胆总管行端-端吻合。结果供、受者手术均成功。供者术后恢复顺利,受者术后8 h 恢复意识,14 d 后丙氨酸转氨酶、总胆红素等指标首次下降至正常水平。术后16 d 曾出现转氨酶明显升高,给予甲泼尼龙1000 mg 冲击治疗后恢复正常。随访至今,供受者已健康生存8个月,均未出现胆管、肝动脉及静脉回流等并发症。结论扩大右半肝移植在技术上完全可行,能为成人患者提供足够重量的移植物,尤其对于急性肝功能衰竭患者具有重要意义,术前精确的影像学评估,熟练的肝切除和肝移植技术是确保该类手术成功的关键因素。

Objective To report experience in adult-to-adult living donor liver transplantation for acute liver failure using extended right lobe graft. Methods A 42-year-old male with acute liver failure received adult-to-adult living donor liver transplantation using extended right lobe graft. Volumetric analysis with computed tomography （CT） revealed that the volume of donor＇s extended right liver with medial hepatic vein （MHV） amounted to approximately 1.3% of the recipient＇s body weighL The donor hepatic vein and recipient inferior vena cava were reconstructed and then anastomosed end to side. The portal veins, hepatic arteries and bile ducts were anastomosed end-to-end, respectively. Results The operations in donor and recipient were all successful. The donor recovered uneventfully. The recipient regained consciousness in 8 hours and got normal liver function 14 days after transplantation. On day 16 after transplantation, transaminases such as alanine transaminase, aspartate transaminase rised expeditiously in the recipient and was controlled effectively with methylprednisolone（ 1000 mg）. The recipient and donor has survived for 8 months healthily without vascular and bile duct complications. Conclusions Adult-to-adult living donor liver transplantation for acute liver failure using extended right lobe graft can achieve superior results when performed by an experienced team in hepatectomy and transplantation. This technique extends the success of living donor liver transplantation and opens a new donor pool for adults to receive a timely graft of adequate function.