1歳未満で生体肝移植をした胆道閉鎖症児の発達経過

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  • 金澤 郁恵
    国立成育医療研究センターリハビリテーション科
  • 佐島 毅
    筑波大学人間系
  • 川島 瞳
    国立成育医療研究センターリハビリテーション科
  • 大久保 浩子
    国立成育医療研究センターリハビリテーション科
  • 橋本 圭司
    国立成育医療研究センターリハビリテーション科
  • 内田 孟
    国立成育医療研究センター臓器移植センター
  • 福田 晃也
    国立成育医療研究センター臓器移植センター
  • 阪本 靖介
    国立成育医療研究センター臓器移植センター
  • 笠原 群生
    国立成育医療研究センター臓器移植センター

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タイトル別名
  • Development in infants following living donor liver transplantation for biliary atresia

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<p>【Objective】 Significant improvements in survival and physical growth in infants following living donor liver transplantation (LDLT) for biliary atresia (BA) have been reported. However, cognitive and psychological development in infants after LDLT has not been well documented. We analyzed the physiological development of infantile transplant recipients with BA, especially those at one year post transplantation.</p><p>【Methods】 Eight BA patients younger than 1 year at the time of transplantation were enrolled between November 2013 and November 2014. All patients underwent physical therapy post transplantation. Psychophysical development was assessed using the Kyoto Scale of Psychological Development (KSPD) before the therapy, at the time of discharge, and one year after LDLT. The age of the patients ranged from 4 to 11 months. They had all received the diagnosis of type III BA and had undergone a Kasai portoenterostomy before age 5 months. The pediatric end-stage liver disease (PELD) score ranged from 6 to 21, and the Child-Pugh score was either grade B or C for all the patients.</p><p>【Results】 Five patients weighed less than −2SD preoperatively but approached the normal range in the following year. The height of one patient remained −2SD even one year after LDLT. All the patients had achieved head control and the ability to roll on the floor prior to the LDLT, and were able to walk within one year following the operation. The KSPD development quotient indicated that the postural-motor score was much lower than the cognitive-adaptive and language-social ability scores at the time of the LDLT and discharge but that it had improved one year later.</p><p>【Conclusion】 BA patients who received a LDLT in their infancy showed significant developmental delay even one year after the operation. These results suggest that perioperative management is necessary for normal psychosocial development in these patients.</p>

収録刊行物

  • 移植

    移植 52 (6), 525-531, 2017

    一般社団法人 日本移植学会

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