肝脏移植治疗自身免疫性肝炎2例报告并文献复习

目的探讨肝脏移植治疗终末期自身免疫性肝炎(autoimmune hepatitis,AIH)的疗效。方法对2例AIH肝硬化患者行肝脏移植手术(1例行经典原位肝脏移植术,1例行背驮式肝脏移植术),其中1例患者术中同时行脾切除术。术后应用他克莫司+麦考酚吗乙酯+甲泼尼龙三联免疫抑制方案治疗。结果 2例手术顺利,行脾切除术的患者术后19 d肠系膜上静脉血栓形成,给予抗凝、溶栓等治疗1周后缓解。2例患者术后均未出现排斥反应及其它并发症,出院时肝功能恢复正常,抗核抗体(ANA)转阴。随访至投稿日,两例已分别健康存活68个月及20个月,没有复发表现。结论肝移植术可作为治疗终末期AIH的有效手段,并可获得良好的长期效果。

Liver transplantation for the treatment of autoimmune hepatitis:a report of 2 cases

Objective To evaluate the therapeutic effect of liver transplantation in the treatment of autoimmue hepatitis （AIH） . Methods Two cases of AIH patients with cirrhosis were treated by liver transplantation. One patient underwent orthotopic liver transplantation and the other one underwent piggyback liver transplantation with splenectomy. The patients received triple immunosuppression including tacrolimus, mycophenolate mofetil and methylprednisolone after operation. Results Successful operations were performed in the two patients. The patient undergoing spleneetomy developed superior mesenterie venous thrombosis 19 days after liver transplantation and was cured with antieoagulation and thrombolysis treatment. Neither acute rejection nor other complication was observed in these two patients. Both patients had normal liver function and negative antinuclear antibody （ANA） at the time of discharge from the hospital. The two patients have already survived for 68 and 20 months respectively up till now, with normal liver function and negative ANA. No episode of rejection and recurrence was observed during follow up. Conclusion Liver transplantation is an effective treatment for end-stage AIH with excellent long-term prognosis.