Journal of Nippon Medical School: Vol.70 No.6 page.522

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ArticleTitle 生体肝移植の術後管理と合併症

AuthorList 清水哲也^{1, 2}, 田尻孝¹, 秋丸琥甫¹, 吉田寛¹, 横室茂樹¹, 真々田裕宏¹, 谷合信彦¹, 川野陽一¹, 水口義昭¹, 高橋翼¹, 水田耕一², 河原崎秀雄²

Affiliation ¹日本医科大学大学院医学研究科臓器病態制御外科学
²自治医科大学小児外科・移植外科

Language JA

Volume 70

Issue 6

Year 2003

Page 522-527

Received April 28, 2003

Accepted July 30, 2003

Keywords living-related liver transplantation, complication

Abstract Living-related liver transplantation is widely accepted as a treatment for patients with end-stage liver disease, with survival rates of up to 80%. Liver transplant recipients are at risk for the same postoperative complications as any patient undergoing a major intraabdominal operation, in addition to several complications specific to this procedure.
Maintenance immunosuppression relies principally on administration of tacrolimus and methylprednisolone. Nevertheless, approximately 36% of liver transplant recipients suffer acute rejection in the early posttransplant period and require bolus steroid therapy as a rescue agent.
Vascular complications, including hepatic arterial thrombosis and portal vein thrombosis, are additional major problems. When they occur in the immediate postoperative period, they can produce fulminant hepatic necrosis requiring retransplantation, so intensive anticoagulation therapy is needed as prophylaxis against these vascular complications. If thrombosis of the hepatic artery or portal vein is diagnosed early in the postoperative course, emergency thrombectomy with reanastomosis should be attempted. Outflow obstruction by hepatic vein stenosis sometimes causes liver dysfunction, pleural effusion, and hepatosplenomegaly. Percutaneous transhepatic or transjugular approached hepatic vein dilatation is very useful in case of hepatic vein stenosis.
Recipients are generally immunocompromised secondary to immunosuppressive therapy and their poor clinical condition and are at high risk for postoperative infection. Infection is a major cause of morbidity and the most common cause of death in liver transplant recipients. Antibiotic, antifungal, and antiviral agents are used empirically, and serologic examinations and bacterial investigations of blood, sputum, stool, urine, and discharge from drains should be performed as well as antibiotic sensivity tests when necessary.
Other complications related to the operation are intraabdominal bleeding, bile leakage, biliary anastomotic stenosis, and intestinal perforation. The postoperative course of liver transplant recipients with these complications depends on making an accurate diagnosis promptly and initiating appropriate management.
Postoperative complications of living-related liver transplantation are protean, so it is very important to communicate with professionals in each specialized field to ensure optimal treatment.

Correspondence to Tetsuya Shimizu, MD, Graduate School of Medicine, Surgery for Organ Function and Biology Regulation, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
tetsuya@nms.ac.jp

ArticleTitle	生体肝移植の術後管理と合併症
AuthorList	清水哲也^{1, 2}, 田尻孝¹, 秋丸琥甫¹, 吉田寛¹, 横室茂樹¹, 真々田裕宏¹, 谷合信彦¹, 川野陽一¹, 水口義昭¹, 高橋翼¹, 水田耕一², 河原崎秀雄²
Affiliation	¹日本医科大学大学院医学研究科臓器病態制御外科学 ²自治医科大学小児外科・移植外科
Language	JA
Volume	70
Issue	6
Year	2003
Page	522-527
Received	April 28, 2003
Accepted	July 30, 2003
Keywords	living-related liver transplantation, complication
Abstract	Living-related liver transplantation is widely accepted as a treatment for patients with end-stage liver disease, with survival rates of up to 80%. Liver transplant recipients are at risk for the same postoperative complications as any patient undergoing a major intraabdominal operation, in addition to several complications specific to this procedure. Maintenance immunosuppression relies principally on administration of tacrolimus and methylprednisolone. Nevertheless, approximately 36% of liver transplant recipients suffer acute rejection in the early posttransplant period and require bolus steroid therapy as a rescue agent. Vascular complications, including hepatic arterial thrombosis and portal vein thrombosis, are additional major problems. When they occur in the immediate postoperative period, they can produce fulminant hepatic necrosis requiring retransplantation, so intensive anticoagulation therapy is needed as prophylaxis against these vascular complications. If thrombosis of the hepatic artery or portal vein is diagnosed early in the postoperative course, emergency thrombectomy with reanastomosis should be attempted. Outflow obstruction by hepatic vein stenosis sometimes causes liver dysfunction, pleural effusion, and hepatosplenomegaly. Percutaneous transhepatic or transjugular approached hepatic vein dilatation is very useful in case of hepatic vein stenosis. Recipients are generally immunocompromised secondary to immunosuppressive therapy and their poor clinical condition and are at high risk for postoperative infection. Infection is a major cause of morbidity and the most common cause of death in liver transplant recipients. Antibiotic, antifungal, and antiviral agents are used empirically, and serologic examinations and bacterial investigations of blood, sputum, stool, urine, and discharge from drains should be performed as well as antibiotic sensivity tests when necessary. Other complications related to the operation are intraabdominal bleeding, bile leakage, biliary anastomotic stenosis, and intestinal perforation. The postoperative course of liver transplant recipients with these complications depends on making an accurate diagnosis promptly and initiating appropriate management. Postoperative complications of living-related liver transplantation are protean, so it is very important to communicate with professionals in each specialized field to ensure optimal treatment.
Correspondence to	Tetsuya Shimizu, MD, Graduate School of Medicine, Surgery for Organ Function and Biology Regulation, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan tetsuya@nms.ac.jp