急诊右半肝活体肝移植治疗急性肝衰竭

Emergency living donor liver transplantation using right lobe graft for acute liver failure

目的 探讨急诊右半肝活体肝移植（living donor liver transplantation，LDLT）治疗急性肝衰竭（acute liver failure，ALF）的价值。方法 同顾性分析我院自2006年11月至2007年2月6例接受急诊LDLT的ALF患者临床资料，评价转归和疗效。结果 全部供体术后均未发生严重并发症或死亡，3周后恢复日常生活。全部受体均接受不含肝中静脉的右半肝，手术顺利，术后48h内苏醒，未发生神经系统并发症。与术前水平相比，血氨术后第1天明显下降至（53.3±21.6）μmol/L （P〈0.05）；总胆红素（TB）术后第1天即可恢复至（212±130）μmol/L（P〈0.05），以后呈继续下降趋势；凝血酶原时间（PT）术后1周内即可降至正常水平（13±1）s（P〈0.05）；国际标准化比值（INR）变化与PT类似；丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）术后1周内持续下降，至术后第7天降至较低水平。1例患者术后第10天发生急性排斥反应经激素冲击疗法治愈，其余5例均未发生严重并发症。全组受体均于术后1月内康复出院。结论 急诊右半肝LDLT能有效治疗ALF。

Objective To evaluate the efficiency of emergency living donor liver transplantation （LDLT） using right lobe graft in patients with acute liver failure （ALF）. Methods The clinical data of 6 patients with ALF receiving emergency LDLT between November 2006 and February 2007 was retrospectively reviewed. Liver function during the first post-transplant week was recorded and compared with the pretransplant levels. Results There was not severe complication nor mortality among donors, All recipients received the right lobe graft （without inclusion of middle hepatic vein ） and completely regained consciousness within 48 h post-transplantation. The serum levels of liver function significantly improved comparing with pre-transplant levels, Compared to the pre-transplant serum levels, the serum level of ammonia significantly decreased to （53.3 ±21.6）μmol/L （P 〈 0. 05 ） on post-transplant day 1, the serum level of total bilirubin （ TB ） decreased to （ 212 ± 130） μmol/L （ P 〈 0. 05 ） on post-transplant day 1 and on steady decrease in the following days. The prothrombin time （PT） decreased to normal level during the first post-transplant week （ P 〈0. 05 ）, the serum levels of aminoleucine transferase （ALT） and aspartate aminotransferase （AST） decreased to relatively low level during the first post-transplant week. There was no severe complications among the 5 recipients. One patient suffered from acute hepatic rejection in post- transplant day 10 and was cured by high-dose prednisone. All recipients were discharged within 1 month post-transplantation. Conclusion Emergency LDLT is an effective salvage for ALF patients.