肝移植治疗妊娠期合并急性肝衰竭2例并文献复习

唐晖; 傅斌生; 易慧敏; 汪国营; 张英才; 易述红; 张剑; 汪根树; 李华; 杨扬; 陈规划

doi:10.3969/j.issn.1674-7445.2015.06.008

肝移植治疗妊娠期合并急性肝衰竭2例并文献复习

doi: 10.3969/j.issn.1674-7445.2015.06.008

510630 广州, 中山大学附属第三医院肝移植中心

基金项目:

国家自然科学基金 81370575

国家自然科学基金 81372243

国家自然科学基金 81172036

国家十二五科技重大专项 2012ZX10002016-023

国家十二五科技重大专项 2012ZX10002017-005

广东省科技计划项目 2014A020211015

广州市科技计划项目 201400000001-3

广州市科技计划项目 2014J4100183

详细信息

通讯作者:
陈规划, Email:chgh1955@263.net

中图分类号: R617;R714
计量
- 文章访问数: 70
- HTML全文浏览量: 33
- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2015-08-20
- 网络出版日期: 2021-01-19
- 刊出日期: 2015-11-15

Treatment of liver transplantation on acute liver failure of pregnancy: a report of two cases and literature review

Organ Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China

More Information

Corresponding author: Chen Guihua, Email:chgh1955@263.net

摘要

摘要: 目的探讨肝移植治疗妊娠期合并急性肝衰竭的疗效。方法回顾性分析2004年3月至2015年6月在中山大学附属第三医院接受肝移植的2例妊娠期合并急性肝衰竭患者的临床资料。结果例1患者因妊娠自然分娩后慢性乙型病毒性肝炎(乙肝)迅速发展而致亚急性肝衰竭, 急诊行肝移植术。例2患者急性肝衰竭病因不明, 因宫内胎儿已是死胎, 在急诊行肝移植后第2日, 由产科医师继续行子宫次全切除术。两例患者术后早期免疫抑制方案均为他克莫司(FK506)+肾上腺皮质激素(激素)。例1患者术后加强抗乙型肝炎病毒治疗, 抗病毒方案为恩替卡韦联合乙肝免疫球蛋白。因例1患者术后仍有继续妊娠的意愿, 在移植物功能稳定后, 使用单一最小剂量免疫抑制剂。例2患者已无妊娠能力, 按常规进行移植术后处理。随访至投稿日, 2例患者恢复良好, 例1未见乙肝复发并且已再次成功分娩1名男婴。结论妊娠期急性肝衰竭患者行肝移植治疗可获得良好疗效。
- 肝移植 /
- 妊娠 /
- 肝衰竭, 急性 /
- 疗效
Abstract: Objective To investigate the curative effect of liver transplantation on acute liver failure of pregnancy. Methods Clinical data of 2 patients with acute liver failure of pregnancy undergoing liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University from March 2004 to June 2015 were retrospectively studied. Results The patient of case 1 developed subacute liver failure and underwent emergency liver transplantation, because chronic viral hepatitis B (HBV) progressed quickly after natural delivery. The patient of case 2 developed acute liver failure with unknown etiology, and underwent subtotal hysterectomy by the obstetrician on the following day of emergency liver transplantation because the intrauterine fetus was dead. The two patients were given tacrolimus (FK506) and adrenocortical hormone as the postoperative early immunosuppressive regimen. Anti-HBV treatment was enhanced for the patient of case 1 with the antivirus regimen of entecavir combined with hepatitis B immune globulin. The patient of case 1 was willing to continue pregnancy, so the minimal dose of a single immunosuppressant was used when the graft function was stable. The patient of case 2 had no ability of pregnancy and underwent routine postoperative management. The two patients were followed up till the date of submission and they recovered well. The patient of case 1 had no recurrence of HBV and delivered a baby boy successfully. Conclusions Liver transplantation on acute liver failure of pregnancy may obtain good curative effect.
- Liver transplantation /
- Pregnancy /
- Liver failure, acute /
- Curative effect

HTML全文

参考文献(17)

[1]	Westbrook H, Yeoman D, Agarwal K, et al. Outcomes of pregnancy following liver transplantation: The King's College Hospital experience[J]. Liver Transpl, 2015, DOI: 10.1002/lt.24182[Epub ahead of print].
[2]	Matin A, Sass A. Liver disease in pregnancy[J]. Gastroenterol Clin North Am, 2011, 40(2): 335-353. doi: 10.1016/j.gtc.2011.03.010
[3]	Lopez-Cepero R, de la Vega A, Lynch L. Pregnancy after liver transplantation[J]. Bol Asoc Med P R, 2013, 105(1): 9-13. http://cn.bing.com/academic/profile?id=2124614301&encoded=0&v=paper_preview&mkt=zh-cn
[4]	Fikatas P, Lee E, Sauer M, et al. APACHE Ⅲ score is superior to King's College Hospital criteria, MELD score and APACHE Ⅱ score to predict outcomes after liver transplantation for acute liver failure[J]. Transplant Proc, 2013, 45(6): 2295-2301. doi: 10.1016/j.transproceed.2013.02.125
[5]	O'Grady J. Timing and benefit of liver transplantation in acute liver failure[J]. J Hepatol, 2014, 60(3): 663-670. doi: 10.1016/j.jhep.2013.10.024
[6]	Alvaro E, Jimenez C, Palomo I, et al. Pregnancy and orthotopic liver transplantation[J]. Transplant Proc, 2013, 45(5): 1966-1968. doi: 10.1016/j.transproceed.2013.01.013
[7]	Maddukuri C, Stephenson D, Eskind L, et al. Liver transplantation for acute liver failure at 11-week gestation with successful maternal and fetal outcome[J]. Case Rep Transplant, 2012: 484080. http://cn.bing.com/academic/profile?id=1973980184&encoded=0&v=paper_preview&mkt=zh-cn
[8]	Kanogawa N, Kanda T, Ohtsuka M, et al. Acute liver failure occurring during the first trimester of pregnancy successfully treated with living donor liver transplantation[J]. Case Rep Transplant. 2013: 309545. http://cn.bing.com/academic/profile?id=2130072132&encoded=0&v=paper_preview&mkt=zh-cn
[9]	Mendizabal M, Rowe C, Piñero F, et al. Successful orthotopic liver transplantation and delayed delivery of a healthy newborn in a woman with fulminant hepatic failure during the second trimester of pregnancy[J]. Ann Hepatol, 2014, 13(2):288-292. http://cn.bing.com/academic/profile?id=2188342869&encoded=0&v=paper_preview&mkt=zh-cn
[10]	Kubo S, Uemoto S, Furukawa H, et al. Pregnancy outcomes after living donor liver transplantation: results from a Japanese survey[J]. Liver Transpl, 2014, 20(5):576-583. doi: 10.1002/lt.v20.5
[11]	Kimmich N, Dutkowski P, Krähenmann F, et al. Liver transplantation during pregnancy for acute liver failure due to HBV infection: a case report[J]. Case Rep Obstet Gynecol, 2013:356560. http://cn.bing.com/academic/profile?id=2141208758&encoded=0&v=paper_preview&mkt=zh-cn
[12]	Simsek Y, Isik B, Karaer A, et al. Fulminant hepatitis A infection in second trimester of pregnancy requiring living-donor liver transplantation[J]. J Obstet Gynaecol Res, 2012, 38(4):745-748. doi: 10.1111/j.1447-0756.2011.01757.x
[13]	Agren A, Stål P, Agvald-Ohman C, et al. Life-saving transplantation in pregnancy-related liver failure. well functioning care continuity contributed to the good result[J]. Lakartidningen(瑞典文), 2011, 108(3):92-95. http://cn.bing.com/academic/profile?id=2418208669&encoded=0&v=paper_preview&mkt=zh-cn
[14]	Alvaro E, Jimenez C, Palomo I, et al. Pregnancy and orthotopic liver transplantation[J].Transplant Proc, 2013, 45(5): 1966-1968. doi: 10.1016/j.transproceed.2013.01.013
[15]	Hammoud GM, Almashhrawi AA, Ahmed KT, et al. Liver diseases in pregnancy: liver transplantation in pregnancy[J]. World J Gastroenterol, 2013, 19(43): 7647-7651. doi: 10.3748/wjg.v19.i43.7647
[16]	Rodríguez-Perálvarez M, De la Mata M, Burroughs AK. Liver transplantation: immunosuppression and oncology[J]. Curr Opin Organ Transplant, 2014, 19(3): 253-260. doi: 10.1097/MOT.0000000000000069
[17]	Donzelli G, Paddeu EM, D'Alessandro F, et al. The role of narrative medicine in pregnancy after liver transplantation[J]. J Matern Fetal Neonatal Med, 2015, 28(2):158-161. doi: 10.3109/14767058.2014.906578