肝移植とアフェレシス

概要

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Liver transplantation has been widely recognized as a treatment for the end-stage liver disease. But it still has many problems, such as donor shortage, ABO-incompatible transplantation, and posttransplant liver failure. In this review, the criteria and the effectiveness of the apheresis for liver transplant patients are discussed from the respect of artificial liver support and extracorporeal immunomodulation. For the bridge use of apheresis until liver transplantation, plasmapheresis (PP) and continuous hemodiafiltration (CHDF) are mainly used in terms of detoxification and supplement of liver products. In this condition, fresh frozen plasma is the replacement fluid for the coagulation factors and other deficient materials not produced by the damaged liver. The pretransplant apheresis is effective for the reduction of antibody titers such as anti-A or anti-B antibody and antidonor antibody. The postoperative apheresis contributes to improvement of the condition for liver transplant recipients who have hyperbilirubinemia and drug induced renal failure. But apheresis is not effective for recipients with multiple organ failure. Apheresis is option for the treatment of posttransplant liver dysfunction, but the indication should be considered carefully in each case.
日本アフェレシス学会の論文
2001-05-30