| 特集名 | 原発性硬化性胆管炎(PSC) | |
|---|---|---|
| 題名 | PSCの治療 (3) 肝移植(外国での適応) | |
| 発刊年月 | 1998年 02月 | |
| 著者 | 佐々木 睦男 | 弘前大学医学部第二外科 |
| 【 要旨 】 | 原発性硬化性胆管炎(PSC)に対する肝移植適応について，教室症例と文献的考察を行った．教室症例は31歳，女性で，肝左葉を移植片とする生体肝移植を行い，術後2年2カ月現在良好に経過している． PSCに対する肝移植のタイミングはMayo modelを参考にしながら決定されているのが現状で，その中で血清ビリルビン値，生検像，年齢，脾腫がrisk scoreとして重要であった．また，risk score 4以上になるとincidental tumor(cholangiocarcinoma)を合併することが多く，その術後成績は不良であった．移植肝におけるPSC再発率は約10～20%であり，1,2，5年生存率はほぼ95%，90%，85%でPSCは肝移植の良い適応疾患である． |
|
| Theme | Primary Sclerosing Cholangitis | |
|---|---|---|
| Title | Treatment of Primary Sclerosing Cholangitis : Liver Transplantation (Indication in Foreign Country) | |
| Author | Mutsuo Sasaki | Department of Surgery, Hirosaki University School of Medicine |
| [ Summary ] | Operative indications and the results of primary sclerosing cholangitis were reviewed with a presentation of one case at our department. The patient, is a 31-year-old female, underwent living related liver transplantation with a left lobe graft (500g, 42.3% of estimated ideal liver weight) on September 9, 1995. She is currently doing well 2 years and 2 months after transplantation with an immunosuppressive regimen including steroids and FK506. The Mayo model of the natural history, in which bilirubin, histological stage, age, and splenomegaly were employed to calculate risk scores, is often referred to in determining the timing of liver transplantation for primary sclerosing cholangitis. Since primary sclerosing cholangitis has been reported to be a premalignant condition leading to cholangiocarcinoma development, liver transplantation has been offered to patients even in the relatively early stage. Namely, patients with a risk score exceeding greater than 4 occasionally develop incident cholangiocarcinoma. Thus, the Mayo model contributes to timing of liver transplantation. The recurrence rate of primary sclerosing cholangitis has been reported to be 10 to 20% and histological investigation is important for making a definite diagnosis of recurrence. Patient survivals at 1, 2, and 3 years are 95%, 90% and 85%, respectively, and the good prognosis after transplantation suggests primary sclerosing cholangitis to be a good indication for liver transplantation. |
|