自験例生体肝移植の問題点と予後からみた今後の展望

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  • Prospective Evaluation from the View Points of Prognosis and Complications after Living Related Liver Transplantation. 12 Cases Experienced in Our Institution.

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The purpose of this study was to evaluate the problems and to estimate the possibility of living related liver transplantation (LRLT) from the viewpoints of complications and prognosis. One adult and 11 pediatric patients, including 8 with biliary atresia, 2 with Alagille syndrome, one with fulminant hepatitis and the one with primary sclerosing cholangitis, have received LRLT in Nagoya City University hospital. Three pediatric patients and the one adult were ABO-incompatible, one was ABO-compatible, and the remaining 8 were identical. Operations included 11 elective and one relative emergency operation, and were performed at intervals of 3 to 6 months. Five patients died within one month, whereas 7 cases could be followed alive for periods of 9 months to 4 years. The successfully treated patients were free from any liver damage due to administration of a single immunosuppressive drug: 4 treated with cyclosporine and 3 treated with FK506. The fatalities were due to massive infections related to hepatic decompensation from portal or hepatic arterial thromboses. The results of our LRLT were considered to depend upon the preoperative condition of the patients. Two of the 7 survivors were maintained on low doses of drugs. Two successful ABO-incompatible cases that were ABO group O, had markedly decreased anti-donor antibody titers, whereas they showed no marked changes in non anti-donor titers. We conclude that LRLT should be attempted as early as possible and before development of pronounced hepatic decompensation in those cases where it is indicated.

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