胆胰分流后肝移植1例:友好共存?

Q4 Medicine
Sébastien Frey , Lidia Santarpia , Madleen Chassang , Anne-Sophie Schneck , Rodolphe Anty , Jean Gugenheim , Antonio Iannelli
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引用次数: 0

摘要

今天,减肥手术已经成为对抗全球日益增长的肥胖的主要治疗手段。此外,非酒精性脂肪性肝炎扩大了肝移植的适应症。肝移植外科医生容易面对越来越多这样背景的患者。在这里,我们报告了首例肝细胞癌患者的肝移植,该患者既往有胆胰转流伴十二指肠转流的病史。胆胰转流合并十二指肠转流是目前一种不常见的减肥手术,但通常是袖式胃切除术后的第二阶段手术。肝移植具有挑战性,因为这种减肥手术重塑了消化结构,也可能导致营养不良。如果没有这种并发症,并且在一个专门从事减肥手术和肝移植的中心,这样的病例可能是成功的,不应该引起肝移植外科医生的警惕。在我们的病例中,肥胖解剖结构被保留,肝移植成功,没有术后免疫抑制治疗的困难。然而,长期随访显示,骨骼肌减少症水平加剧,更需要在这类候选人的围手术期进行精心计划的身体和营养康复。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A case report of liver transplantation following a biliopancreatic diversion: A friendly cohabitation?

Today, bariatric surgery has become the main therapeutic means to fight against the escalating increase in obesity, worldwide. Besides that, non-alcoholic steatohepatitis has inflated its indication for liver transplantation. Liver transplant surgeons are prone to face more and more patients with such background. Here, we described the first case of liver transplantation for hepatocellular carcinoma in a patient with previous history of biliopancreatic diversion with duodenal switch. Biliopancreatic diversion with duodenal switch is nowadays an uncommon bariatric surgery but use to be a second stage surgery following sleeve gastrectomy. Liver transplantation can be challenging as such bariatric procedure reshape the digestive anatomy and can also be responsible for malnutrition. Without such complication and in a center specialized in bariatric surgery and liver transplantation, such cases can be successful and should not alarm liver transplant surgeons. In our case, the bariatric anatomy was conserved, and the liver transplantation was successful, without difficulty of the post-operative immunosuppressive treatment. However, long term follow-up showed an exacerbation of the sarcopenia level and establish even more the need for an association of a well-planned physical and nutritional rehabilitation in the peri-operative period in such candidate.

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来源期刊
Transplantation Reports
Transplantation Reports Medicine-Transplantation
CiteScore
0.60
自引率
0.00%
发文量
24
审稿时长
101 days
期刊介绍: To provide to national and regional audiences experiences unique to them or confirming of broader concepts originating in large controlled trials. All aspects of organ, tissue and cell transplantation clinically and experimentally. Transplantation Reports will provide in-depth representation of emerging preclinical, impactful and clinical experiences. -Original basic or clinical science articles that represent initial limited experiences as preliminary reports. -Clinical trials of therapies previously well documented in large trials but now tested in limited, special, ethnic or clinically unique patient populations. -Case studies that confirm prior reports but have occurred in patients displaying unique clinical characteristics such as ethnicities or rarely associated co-morbidities. Transplantation Reports offers these benefits: -Fast and fair peer review -Rapid, article-based publication -Unrivalled visibility and exposure for your research -Immediate, free and permanent access to your paper on Science Direct -Immediately citable using the article DOI
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