九州大学病院第三内科における急性肝不全の治療 : 生体肝移植への適応検討

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タイトル別名
  • Evaluation of Acute Hepatic Failure Treated at the Department of Medicine III, Kyushu University Hospital : Indications for Living-donor Liver Transplantation
  • キュウシュウ ダイガク ビョウイン ダイ3 ナイカ ニ オケル キュウセイ カンフゼン ノ チリョウ セイタイ カンイショク エ ノ テキオウ ケントウ

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To evaluate indications for living-donor liver transplantation (LDLT), we examined 25 consecutive patients with acute hepatic failure admitted to the Department of Medicine III, Kyushu University Hospital between November 2001 and July 2004. These cases were diagnosed as fluminant hepatitis (n=13), severe-type acute hepatitis (n=11), or late-onset hepatic failure (n=1). Nine patients (36 %) improved with conservative treatment (conservative treatment group), and the other 16 patients (64 %) needed LDLT (LDLT indicated group). In the LDLT indicated group, 11 patients received LDLT, and 4 died because of lack of LDLT donors (n=3), or renal failure (n=1). The LDLT survival rate was 82 % (9/11) ; two patients died due to hepatic infarction and brain edema, respectively. It is very important to predict whether a patient with acute hepatic failure belongs to the conservative treatment group or the LDLT indicated group on admission. Therefore, we analyzed variables that could influence prognosis, including, parameters of hepatic function and platelet counts on admission, and relative hepatic volume (%), which represents the ratio of hepatic volume measured by CT relative to standard hepatic volume calculated with body surface area. Univariate logistic analysis showed that relative hepatic volume, gammaglutamyl transpeptidase (γ-GTP), alkaline phosphatase (ALP), and the ratio of direct bilirubin to total bilirubin (DB/TB) were significant predictors of survival (p < 0.05). Using these factors plus prothrombin time (PT) and total cholesterol, both of which were relatively significant predictors of survival (p < 0.2), we proposed a model for predicting the probability of survival by the stepwise method. Consequently, we proposed a model using four parameters : ALP, GGTP, PT, and relative hepatic volume (Volume) as shown below : P(%) = 1/1+exp { ?(-36 .2375+ALP x 0.0251+ γ-GTP x 0.0102+PT x 0.2558+Volume x 21.2158)} ×100 This model showed a significant correlation between prediction and consequence of survival (r2 = 0.7388, p = 0.0003). In conclusion, LDLT is an effective treatment for acute hepatic failure. The results of this study suggested that our model can adequately predict prognosis in the early phase of acute hepatic failure.

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