Outflow blockの所見を伴った高度急性拒絶反応を呈した生体部分肝移植の1例

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The patient was a 38-year-old woman with primary biliary cirrhosis. A living related liver transplantation was performed. The donor was her sister. The extended left lobe of the donor was transplanted. Tacrolimus and methylprednisolone were used for immunosuppression. Seven days later, we found through Doppler ultrasonography that she had a flat wave form of blood flow in the hepatic vein and an outflow block was detected. But the hepatic vein stenosis was not detected by the angiogram of the hepatic vein. Liver dysfunction occurred at once. We thought it a rejection, and started steroid pulse therapy. Through levels were around 16～25 ng/ml. Then liver biopsy was performed. The histopathology of the liver biopsy specimen showed the portal infiltration, the zone III necrosis, the endothelialitis of the central vein and the portal vein. We diagnosed the acute severe rejection and started to use the azathioprine. Ten days later, the outflow block improved. She was discharged from our hospital 94 days after the operation. Because the outflow block improved after the steroid pulse therapy, we think the outflow block may be related to the rejection.
東京女子医科大学の論文
2002-06-25