Bridge Therapy to Living-related Liver Transplantation in Fulminant Hepatic Failure
To evaluate bridge therapy to living donor liver transplantation (LRLT) in fulminant hepatic failure (FHF), we examined 12 patients with FHF undergoing different treatment, judgment of guidelines for liver transplantation of the Japanese Acute Hepatic Failure Study Group, grade of encefphalopathy, g...
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| Published in | Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 24; no. 3; pp. 581 - 587 |
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| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japanese Society for Abdominal Emergency Medicine
2004
日本腹部救急医学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-2242 1882-4781 |
| DOI | 10.11231/jaem1993.24.581 |
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| Abstract | To evaluate bridge therapy to living donor liver transplantation (LRLT) in fulminant hepatic failure (FHF), we examined 12 patients with FHF undergoing different treatment, judgment of guidelines for liver transplantation of the Japanese Acute Hepatic Failure Study Group, grade of encefphalopathy, grade of hepatic atropy, and outcomes. Subjects were 5 men and 7 women aged 0 to 60 years (mean: 32.7 years). The cause of FHF was hepatitis B in 4, unknown in 8. Hepatitis involved 5 acute and 7 subacute. Encephalopathy was grade II in 7, grade III in 3, and grade IV in 1. Prothrombin time in 4 was 10%. After ALS, 4 were treated with living-related liver transplantation (LRLT) and 3 survived. Five died without LRLT and only 3 survived without LRLT. The significance of bridge therapy for FLF is thus considered adequate ALS and appropriate timing of LRLT. |
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| AbstractList | To evaluate bridge therapy to living donor liver transplantation (LRLT) in fulminant hepatic failure (FHF), we examined 12 patients with FHF undergoing different treatment, judgment of guidelines for liver transplantation of the Japanese Acute Hepatic Failure Study Group, grade of encefphalopathy, grade of hepatic atropy, and outcomes. Subjects were 5 men and 7 women aged 0 to 60 years (mean: 32.7 years). The cause of FHF was hepatitis B in 4, unknown in 8. Hepatitis involved 5 acute and 7 subacute. Encephalopathy was grade II in 7, grade III in 3, and grade IV in 1. Prothrombin time in 4 was 10%. After ALS, 4 were treated with living-related liver transplantation (LRLT) and 3 survived. Five died without LRLT and only 3 survived without LRLT. The significance of bridge therapy for FLF is thus considered adequate ALS and appropriate timing of LRLT.
当院にて劇症肝不全症例に対する生体肝移植までの治療戦略を, 劇症肝不全の診断で集中治療を行った12例を対象に, 各症例の移植適応基準判定, 脳症の程度, 肝萎縮, 転帰について検討した。年齢は平均33.0歳 (0～62歳), 男女比5: 7であった。原疾患はB型肝炎4例, 不明8例, また亜急性4例, 急性8例で, 治療開始時脳症II度8例, III度以上が4例であった。PT時間10%以下は4例で, 治療開始時, 移植適応基準を満たしていた症例は8例で, 肝補助療法の再評価にて適応基準を満たしていた症例9例のうち4例は生体肝移植を行い, 2例は救命されたが, 2例は失った。また, 5例は移植されずに失った。全症例の救命率は41.7%であり, 内科的治療のみでは28%, 移植症例は50%であった。肝炎が重症化した場合, 劇症化の防止とともに移植までのbridge useとしての肝補助療法の適切な実施とともに, 移植のタイミングを逸しないことが肝要である。 To evaluate bridge therapy to living donor liver transplantation (LRLT) in fulminant hepatic failure (FHF), we examined 12 patients with FHF undergoing different treatment, judgment of guidelines for liver transplantation of the Japanese Acute Hepatic Failure Study Group, grade of encefphalopathy, grade of hepatic atropy, and outcomes. Subjects were 5 men and 7 women aged 0 to 60 years (mean: 32.7 years). The cause of FHF was hepatitis B in 4, unknown in 8. Hepatitis involved 5 acute and 7 subacute. Encephalopathy was grade II in 7, grade III in 3, and grade IV in 1. Prothrombin time in 4 was 10%. After ALS, 4 were treated with living-related liver transplantation (LRLT) and 3 survived. Five died without LRLT and only 3 survived without LRLT. The significance of bridge therapy for FLF is thus considered adequate ALS and appropriate timing of LRLT. |
| Author | Kawano, Youichi Tajiri, Takashi Takeda, Masahiro Tanaka, Keiji Akimaru, Koho Mamada, Yasuhiro Mizuguchi, Yoshiaki Yoshida, Hiroshi Takahashi, Tsubasa Taniai, Nobuhiko Shimizu, Testuya Yamamoto, Yasuhiro |
| Author_FL | 清水 哲也 田尻 孝 吉田 寛 山本 保博 谷合 信彦 川野 陽一 水口 義昭 高橋 翼 真々田 裕宏 田中 啓治 竹田 晋浩 秋丸 琥甫 |
| Author_FL_xml | – sequence: 1 fullname: 谷合 信彦 – sequence: 2 fullname: 秋丸 琥甫 – sequence: 3 fullname: 川野 陽一 – sequence: 4 fullname: 水口 義昭 – sequence: 5 fullname: 清水 哲也 – sequence: 6 fullname: 高橋 翼 – sequence: 7 fullname: 吉田 寛 – sequence: 8 fullname: 真々田 裕宏 – sequence: 9 fullname: 田尻 孝 – sequence: 10 fullname: 山本 保博 – sequence: 11 fullname: 田中 啓治 – sequence: 12 fullname: 竹田 晋浩 |
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| PublicationTitle_FL | J Abdom Emerg Med 日本腹部救急医学会雑誌 日腹部救急医会誌 Journal of Abdominal Emergency Medicine Nihon Fukubu Kyukyu Igakkai Zasshi |
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| Publisher | Japanese Society for Abdominal Emergency Medicine 日本腹部救急医学会 |
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| References | 3) 大須賀勝, 大村和子, 勝田悌実, ほか: 集学的治療により救命し得た劇症肝不全の1例. J Nippon Med Sch 2002; 69: 390-394. 5) 山岸由幸, 斎藤英胤, 島津元秀, ほか: 当院における急性肝不全治療: 内科・外科連携の重要性. 日消病会誌2002; 99: 1205-1212. 9) Miwa S, Hashikura Y, Mita A, et al: Livingrelated liver transplantation for patients with fulminant and subfulminant hepatic failure. Hepatology 1999; 30: 1521-1526. 2) 杉原潤一, 石木佳英, 内藤智雄, ほか: 劇症肝炎における肝移植適応のガイドライン (案). 肝臓1996; 30: 1521-1526. 1) Yoshiba M, Inoue K, Sekiyama K, et al: Favorable effect of new artificial liver support on survival of patients with fulminant hepatic failure. Artif Organs 1996; 20: 1169-1172. 11) Rolando N, Harvey F, Williams R, et al: Prospective study of bacterial infection in acute liver failure. Hepatology 1999; 11: 49-53. 8) 武藤泰敏, 杉原潤一, 内藤智雄: 劇症肝炎内科治療か肝移植かわが国の急性肝不全の肝移植適応基準. Mod Phys 1999; 19: 1227-1230. 6) 濱崎圭輔, 松本幸二郎, 佐伯哲, ほか: 当科で経験した劇症肝炎10例の検討. 長崎医会誌2002; 77: 814. 10) Uemoto S, Inomata Y, Sakurai T, et al: Living donor lever transplantation for fulminant hepatic failure. Transplantation 2000; 70: 152-157. 7) 安富元彦, 上本伸二, 猪股裕紀洋, ほか: 生体肝移植における肝移植適応基準の検討.肝臓2001, 196, 1105-1110. 4) 持田智, 藤原研司: 我が国における劇症肝炎, LOHFの実態. 日消病会誌2002; 99: 895-904. |
| References_xml | – reference: 7) 安富元彦, 上本伸二, 猪股裕紀洋, ほか: 生体肝移植における肝移植適応基準の検討.肝臓2001, 196, 1105-1110. – reference: 10) Uemoto S, Inomata Y, Sakurai T, et al: Living donor lever transplantation for fulminant hepatic failure. Transplantation 2000; 70: 152-157. – reference: 4) 持田智, 藤原研司: 我が国における劇症肝炎, LOHFの実態. 日消病会誌2002; 99: 895-904. – reference: 5) 山岸由幸, 斎藤英胤, 島津元秀, ほか: 当院における急性肝不全治療: 内科・外科連携の重要性. 日消病会誌2002; 99: 1205-1212. – reference: 11) Rolando N, Harvey F, Williams R, et al: Prospective study of bacterial infection in acute liver failure. Hepatology 1999; 11: 49-53. – reference: 2) 杉原潤一, 石木佳英, 内藤智雄, ほか: 劇症肝炎における肝移植適応のガイドライン (案). 肝臓1996; 30: 1521-1526. – reference: 9) Miwa S, Hashikura Y, Mita A, et al: Livingrelated liver transplantation for patients with fulminant and subfulminant hepatic failure. Hepatology 1999; 30: 1521-1526. – reference: 1) Yoshiba M, Inoue K, Sekiyama K, et al: Favorable effect of new artificial liver support on survival of patients with fulminant hepatic failure. Artif Organs 1996; 20: 1169-1172. – reference: 3) 大須賀勝, 大村和子, 勝田悌実, ほか: 集学的治療により救命し得た劇症肝不全の1例. J Nippon Med Sch 2002; 69: 390-394. – reference: 8) 武藤泰敏, 杉原潤一, 内藤智雄: 劇症肝炎内科治療か肝移植かわが国の急性肝不全の肝移植適応基準. Mod Phys 1999; 19: 1227-1230. – reference: 6) 濱崎圭輔, 松本幸二郎, 佐伯哲, ほか: 当科で経験した劇症肝炎10例の検討. 長崎医会誌2002; 77: 814. |
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| Title | Bridge Therapy to Living-related Liver Transplantation in Fulminant Hepatic Failure |
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