胆道閉鎖症児に対する肝移植の適応決定時期に関する検討

抄録

Hepatic portoenterostomy (Kasai procedure) has shown remarkable improvement in the treatment of biliary atresia. However, because there are not a few patient with unsuccessful portoenterostomies, a liver transplant is the last treatment to save them. One hundred and two patients with biliary atresia were treated by Suruga II modifications from 1977 to 1989 in our institute. In this paper we chose 17 patients with good prognosis (group A) and 27 patients with progressive liver failure (group B) at random from all cases, and retrospectively analysed laboratory data including weight for age as a general index. We concluded as follows : (1) Serum total bilirubin, albumin, and cholinesterase were valuable index to show the timing of liver transplant for biliary atresia. (2) When the following conditions continue for more than 6 months, the patients will possibly die within 6 months, the serum total bilirubin is above 10mg%, albumin is below 3.5g%, cholinesterase reaches below 500IU/1 (normal limit 700-1400). (3) In group B, relative weight gain for age was smaller at 6 months before death than at 12 months before death. When patients with biliary atresia after portoenterostomy reach these conditions, they need a liver transplant urgently.