| 特集名 | 肝移植 ― 現状と展望 | |
|---|---|---|
| 題名 | 原発性胆汁性肝硬変症に対する肝移植 | |
| 発刊年月 | 2013年 08月 | |
| 著者 | 池上 俊彦 | 信州大学医学部附属病院移植外科 |
| 著者 | 宮川 眞一 | 信州大学医学部附属病院移植外科 |
| 【 要旨 】 | 原発性胆汁性肝硬変症（primary biliary cirrhosis；PBC）は自己免疫学的機序により発症すると考えられる，比較的まれな慢性進行性胆汁うっ滞性肝疾患である．本邦では成人に対する肝移植の原疾患のなかで，C型肝炎，B型肝炎に次いで多い．肝移植の適応は他の慢性肝疾患と同様で，非代償性肝硬変や繰り返す食道静脈瘤，肝癌発生例などである．PBCに対する肝移植は本邦においては他の疾患と同様に生体肝移植例が圧倒的に多い．移植後累積生存率は生体肝移植でも脳死肝移植でも良好であり肝移植の良い適応と考えられている．肝硬変への進展例では早期に移植施設にコンサルトすべきである．PBCは移植後に再発することがあるが，移植後10年程度までは生存率に影響することは少ない． | |
| Theme | Liver Transplantation -- Current Status and Perspective | |
|---|---|---|
| Title | Liver Transplantation for Primary Biliary Cirrhosis | |
| Author | Toshihiko Ikegami | Department of Surgery, Shinshu University School of Medicine |
| Author | Shin-ichi Miyagawa | Department of Surgery, Shinshu University School of Medicine |
| [ Summary ] | Primary biliary cirrhosis (PBC), which is classified as an autoimmune disease, is a comparatively rare cholestatic liver condition. In Japanese adults, it is the third most common reason for liver transplantation. As is the case with other chronic liver diseases, liver transplantation is an option for PBC patients who are likely to die due to decompensated liver cirrhosis, those who experience recurrent bleeding from esophageal varices, or those who develop hepatocellular carcinoma. Liver transplantation for PBC is performed predominantly using grafts from living donors as other liver diseases are treated in Japan. Whether grafts are taken from living donors or deceased donors, survival rates for PBC patients after liver transplantation are relatively high. Therefore, patients with PBC are thought to be a good candidates for liver transplantation. Patients with advanced liver cirrhosis should be referred early to transplant centers. PBC may recur after transplants. However, it rarely influences survival rates patients who receive liver transplants have an average post-transplant life span of ten years. |
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