肝移植後に橋中心髄鞘崩壊症を発症した患者に対する包括的ケアにおけるレシピエントコーディネーターの役割

抄録

Since central pontine myelinolysis (CPM) is a demyelinating disease of the pons that is commonly associated with neurological disorders, if it occurs post-transplant in organ recipients, a comprehensive support system including rehabilitation and holistic care should be established. Here, we report our experiences of recipient transplant coordinators (RTC) in promoting cooperation among transplant providers for smooth implementation of the support system.

【Case presentation】 A 60-year-old female patient with acute liver failure with hepatic coma received liver transplantation from a deceased donor. Ten days after transplantation, she developed a neurological disorder, including impaired consciousness and respiratory muscle paralysis. She was diagnosed with CPM, which was possibly associated with immune-suppressive drugs. As a result, the calcineurin inhibitor was switched to everolimus. To restore neurological function, multidisciplinary approaches were implemented, with RTCs promoting cooperation among transplant providers. The RTCs also motivated the recipient to continue her physical rehabilitation. Their positive attitude allowed the patient, as well as the family, to feel relieved from mental distress during the post-transplant period. Although the recipient’s neurological function improved, she required assistance in her activities of daily living. Therefore, the RTCs coordinated the discharge of the recipient to a rehabilitation facility capable of caring for her. The recipient was discharged 140 days after transplantation.

【Conclusion】 It is important to provide holistic supportive care for recipients with neurological disorders due to CPM. RTCs can play a pivotal role in promoting cooperation among transplant providers.