亲属活体肝移植治疗婴儿Crigler-Najjar综合征Ⅰ型1例并文献复习

Living related donor liver transplantation for infant with Crigler-Najjar syndrome type Ⅰ: a report of one case and literature review

  • 摘要:
      目的  总结克里格勒-纳贾尔综合征(CNS)Ⅰ型的亲属活体肝移植治疗效果。
      方法  1例男性3月龄患儿,出生后4 d无明显诱因下出现皮肤、巩膜进行性黄染,完善相关检查后排除其他诱因,并经基因检测鉴定为CNS Ⅰ型。其母亲作为供者,行亲属活体肝移植术。术后常规应用免疫抑制方案,并根据生化指标及受者细胞色素P450(CYP)3A5基因型调整他克莫司剂量。
      结果  受者术后7 d肝酶恢复正常,胆红素逐日下降并于术后22 d降至正常范围。随访至投稿日,受者皮肤巩膜黄染褪去,胆红素正常,肝酶稳定,一般情况佳,生活质量高。
      结论  活体肝移植可治疗CNS Ⅰ型所带来的高非结合胆红素血症等病症,极大提高患者的生活质量。

     

    Abstract:
      Objective  To summarize the therapeutic effects of living related donor liver transplantation for Crigler-Najjar syndrome type Ⅰ (CNS type Ⅰ).
      Methods  A 3-month-old male infant had appeared a progressive xanthochromia of the skin and sclera 4 d after birth without obvious cause. Other causative factors were eliminated after relevant tests were completed, and identified as CNS type Ⅰ by genetic testing. Living related donor liver transplantation was performed with his mother as the donor. An immunosuppression regimen was routinely applied postoperatively and tacrolimus doses were adjusted according to biochemical indicators and cytochrome P450 (CYP) 3A5 genotype of the recipient.
      Results  The liver enzymes of the recipient returned to normal at 7 d postoperatively, and bilirubin decreased daily and fell to the normal range at 22 d postoperatively. Followed up to the submission date, the recipient's xanthochromia of skin and scleral faded with normal bilirubin and stable liver enzymes. The condition of the recipient was generally good with high quality of life.
      Conclusions  Living donor liver transplantation can treat unconjugated hyperbilirubinemia and other diseases caused by CNS type Ⅰ, which greatly improve the quality of life of patients.

     

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