原発性胆汁性肝硬変に対する成人生体部分肝移植の1例

A 49-year-old female received a living related liver transplantation from her son. She had a 13-years history of primary biliary cirrhosis (PBC). The preoperative 1-year survival rate and mortality after 6 months were calculated to be 6.5% and 99.3%, respectively. The graft included left bisegments weighing 435g, and was equal to 43% of the calculated standard liver volume. Massive ascites were sustained due to accompanied portal hypertension. On Postoperative day 7, she manifested massive tarry stool by portal-hypertensive colonopathy. The CT scan revealed a right subphrenic abscess on the postoparative day 14. After drainage of the abscess, the serum total billirubin level decreased to the norman range. She was descharged with extracorptreal tube dainage. On the postoperative day 169, she was readmitted due to acute elevation of the serum bilirubin level. Echography revealed selective dilatation of the hepatic bile duct in the segment 2, and suggested the presence of insufficiency of hepatico-jejunostomy in the early postoperative phase. Despite emergent PTCD, jaundice was sustained and responded poorly to steroid pulse therapy. According to tapering of oral prednisolone, the serum bilirubin level gradually decreased and reached a the plateau between 2 and 4mg/dl. The patient is currently completely free from oral steroid therapy and in receiving interventional hepaticoplasty using the YAG laser system. We concluded that living related liver transplantation is an effective transplantational option for adult end-stage liver disease.

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