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Living-related liver transplantation for patients with primary biliary cirrhosis
Living-Related Liver Transplantation for Patients With Primary Biliary Cirrhosis M. Hirata, Y. Harihara, S. Hisatomi, Y. Miura, H. Yoshino, K. Mizuta, M. Ito, K. Sano, N. Taniai, K. Kusaka, Y. Kita, H. Kawarasaki, K. Kubota, T. Takayama, K. Hashizume, and M. Makuuchi
L
IVER TRANSPLANTATION is the only radical therapy for primary biliary cirrhosis. In this study we assess living-related liver transplantation in eight patients with primary biliary cirrhosis.
ofugal portal flow in one patient. In four patients no complications occurred.
DISCUSSION PATIENTS AND METHODS Patients consisted of seven women and one man with primary biliary cirrhosis (53.5 ⫾ 5.6 years), who underwent living-related liver transplantation from January 1996 to June 1999. The distribution of donors was two sons, two daughters, one brother, one sister, one wife, and one husband. Tacrolimus and methylprednisolone were used for immunosuppression.
RESULTS
Grafts were left lobe in two cases and left lobe plus caudal lobe in six cases. The weight of the grafts was 400.0 ⫾ 63.0 g, which was 40.2 ⫾ 7.8% of the standard liver volume of the recipients.1 Serum total bilirubin level of recipients was 13.6 ⫾ 7.2 mg/dL. The estimated 6-month prognosis based on the Mayo update model2 was 64.0 ⫾ 21.8% (Table 1). The average risk score (Mayo model3 was 8.1 (5.1 to 9.4). Among six patients whose risk scores were ⬎8.0, one patient died on postoperative day 56 because of liver failure after portal vein thrombosis, and another four patients stayed in the hospital for ⬎2 months. In contrast, two patients whose risk scores were ⬍8.0 left the hospital within 50 postoperative days. Other complications included right subphrenic abscess formation in two patients, and hepat-
We performed living-related liver transplantation in eight primary biliary cirrhosis patients. Kim et al4 reported that the risk of death after transplantation increased when the Mayo risk score was ⬎7.8. We observed the same trend in our experience. It is recommended that liver transplantation be performed before the patient status deteriorates using the data based on estimated prognosis or risk score. It remains a controversial issue as to whether primary biliary cirrhosis recurs after liver transplantation.5 In two PBC patients who underwent living-related liver transplantation ⬎1 year ago, level of antimitochondrial antibody did not change. However, there has no evidence of recurrence of primary biliary cirrhosis.
From the Faculty of Medicine, Liver Transplantation Team, University of Tokyo, Tokyo, Japan. Supported in part by grants-in-aid for scientific research from the Ministry of Education, Science and Culture, and from the Ministry of Health and Welfare of Japan (Nos 08407036, 08457294, and 07671292). Address reprint requests to Dr Masaru Hirata, Second Department of Surgery, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan.
Table 1. Study Data Case
Six-Month Survival Rate (Mayo Update)
Risk Score (Mayo)
Days in Hospital
Complication
1 2 3 4 5 6 7 8
65.0 61.7 26.2 82.6 48.3 99.4 59.1 69.6
8.3 8.6 9.4 7.6 8.8 5.1 8.4 8.2
123 110 88 36 48 48 56 90
Abscess Abscess Hepatofugal portal vein flow No No No Portal vein thrombosis No
64.0 ⫾ 21.8
8.1 ⫾ 1.3
74.9 ⫾ 32.2
0041-1345/00/$–see front matter PII S0041-1345(00)01637-7
© 2000 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010
2208
Transplantation Proceedings, 32, 2208–2209 (2000)
LRLT AND BILIARY CIRRHOSIS
REFERENCES 1. Urata K, Kawasaki S, Matsunami H, et al: Hepatology 21:1317, 1995 2. Murtaugh PA, Dickson ER, Van Dam GM, et al: Hepatology 20:126, 1994
2209 3. Dickson ER, Grambsch PM, Fleming TR, et al: Hepatology 10:1, 1989 4. Kim WR, Wiesner RH, Therneau TM, et al: Hepatology 28:33, 1998 5. Water JV, Gerson LB, Ferrell LD, et al: Hepatology 24:1079, 1996
L
IVER TRANSPLANTATION is the only radical therapy for primary biliary cirrhosis. In this study we assess living-related liver transplantation in eight patients with primary biliary cirrhosis.
ofugal portal flow in one patient. In four patients no complications occurred.
DISCUSSION PATIENTS AND METHODS Patients consisted of seven women and one man with primary biliary cirrhosis (53.5 ⫾ 5.6 years), who underwent living-related liver transplantation from January 1996 to June 1999. The distribution of donors was two sons, two daughters, one brother, one sister, one wife, and one husband. Tacrolimus and methylprednisolone were used for immunosuppression.
RESULTS
Grafts were left lobe in two cases and left lobe plus caudal lobe in six cases. The weight of the grafts was 400.0 ⫾ 63.0 g, which was 40.2 ⫾ 7.8% of the standard liver volume of the recipients.1 Serum total bilirubin level of recipients was 13.6 ⫾ 7.2 mg/dL. The estimated 6-month prognosis based on the Mayo update model2 was 64.0 ⫾ 21.8% (Table 1). The average risk score (Mayo model3 was 8.1 (5.1 to 9.4). Among six patients whose risk scores were ⬎8.0, one patient died on postoperative day 56 because of liver failure after portal vein thrombosis, and another four patients stayed in the hospital for ⬎2 months. In contrast, two patients whose risk scores were ⬍8.0 left the hospital within 50 postoperative days. Other complications included right subphrenic abscess formation in two patients, and hepat-
We performed living-related liver transplantation in eight primary biliary cirrhosis patients. Kim et al4 reported that the risk of death after transplantation increased when the Mayo risk score was ⬎7.8. We observed the same trend in our experience. It is recommended that liver transplantation be performed before the patient status deteriorates using the data based on estimated prognosis or risk score. It remains a controversial issue as to whether primary biliary cirrhosis recurs after liver transplantation.5 In two PBC patients who underwent living-related liver transplantation ⬎1 year ago, level of antimitochondrial antibody did not change. However, there has no evidence of recurrence of primary biliary cirrhosis.
From the Faculty of Medicine, Liver Transplantation Team, University of Tokyo, Tokyo, Japan. Supported in part by grants-in-aid for scientific research from the Ministry of Education, Science and Culture, and from the Ministry of Health and Welfare of Japan (Nos 08407036, 08457294, and 07671292). Address reprint requests to Dr Masaru Hirata, Second Department of Surgery, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan.
Table 1. Study Data Case
Six-Month Survival Rate (Mayo Update)
Risk Score (Mayo)
Days in Hospital
Complication
1 2 3 4 5 6 7 8
65.0 61.7 26.2 82.6 48.3 99.4 59.1 69.6
8.3 8.6 9.4 7.6 8.8 5.1 8.4 8.2
123 110 88 36 48 48 56 90
Abscess Abscess Hepatofugal portal vein flow No No No Portal vein thrombosis No
64.0 ⫾ 21.8
8.1 ⫾ 1.3
74.9 ⫾ 32.2
0041-1345/00/$–see front matter PII S0041-1345(00)01637-7
© 2000 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010
2208
Transplantation Proceedings, 32, 2208–2209 (2000)
LRLT AND BILIARY CIRRHOSIS
REFERENCES 1. Urata K, Kawasaki S, Matsunami H, et al: Hepatology 21:1317, 1995 2. Murtaugh PA, Dickson ER, Van Dam GM, et al: Hepatology 20:126, 1994
2209 3. Dickson ER, Grambsch PM, Fleming TR, et al: Hepatology 10:1, 1989 4. Kim WR, Wiesner RH, Therneau TM, et al: Hepatology 28:33, 1998 5. Water JV, Gerson LB, Ferrell LD, et al: Hepatology 24:1079, 1996