林口長庚-肝臟移植

肝臟移植

肝臟移植是目前對於急性肝臟衰竭及肝硬化晚期肝臟衰竭唯一有效的治療方式,對於肝硬化合併早期肝癌(第一、二期)也是治療效果最好的方式。肝臟移植進行的方式,意即是用手術將病肝完全摘除後,再將他人捐贈健康的肝臟整個或部份植入肝病患者體內,以完全替代患者原來的肝臟,發揮肝臟的正常生理機能,讓身體儘快恢復健康,維持病患生命。

新肝的來源可以是善心的大愛器官捐贈的腦死病患,也可以由五等內血親或姻親等親屬捐贈部份肝臟。近20年來,肝臟移植的發展在免疫學的長足發展及新型免疫抑制劑的問世與應用,加上手術與術後醫療照護技術之進步,已成為成熟的臨床治療方法。

1.活體肝臟移植:

經由五等內血親或姻親等親屬捐贈部份肝臟手術移植給肝病患者。

2.血型不相容的活體肝臟移植:

如同輸血,以往器官移植也必須考量血型必須相容,林口長庚醫院於2006年率先完成國內不同血型成人活體肝臟移植之案例,透過術前的準備,血型不相容的親屬也可捐贈部份肝臟移植給受贈者,增加肝病患者透過移植治癒肝病的機會。

3.成人分割肝臟移植:

大愛捐贈之器官得來不易且數量有限,透過分肝手術,可以將一個肝臟分割成左、右半肝,再分別移植給兩位成人的肝病受贈者,增加長久等待肝臟移植病患接受移植的機會,林口長庚肝臟移植團隊於2003年率先完成國內成人分割肝臟移植之案例,為國內此領域經驗豐富的團隊,同時也是國內活躍度高的肝臟移植團隊之ㄧ。

治療經驗

目前已完成肝臟移植手術累計超過1200例,手術成功率大於90%。

肝臟暨移植外科:

李威震教授、詹昆明教授、周宏學醫師、吳庭榕醫師、李正方醫師、吳宗翰醫師、鄭志軒醫師、王瑜肇醫師、李勁樵醫師、洪豪謙醫師、賴殷醫師、鄭思敏協調師、張嘉玲協調師

胃腸肝膽科:

李青松醫師

影像診療科:

潘廣澤醫師、朱崧毓醫師

2003年率先完成將肝臟分割給兩位成人,解決器官短缺的困境,提高末期肝病患者接受肝臟移植的機會,也增加長期等待肝臟移植肝病患者的存活率。至2022年為止已成功完成74位大愛捐贈者之分割肝移植手術,且多位是去外院分割並摘取的肝臟捐贈。

2006年又創下不同血型的活體肝臟移植成功之案例,並克服術後肝臟急性排斥現象。至2022年為止已成功完成136例血型不同之活體肝移植手術。

到目前為止,李威震教授帶領的肝臟移植團隊已成功完成超過千例的肝臟移植手術,包括活體肝臟移植、一肝兩用分肝移植、血型不相容肝臟移植。

來台換了肝 暖了埃及心

在二十年前,60歲的阿底爾(Adel Abdelgalel Mahmoud Abdalla)於埃及當地醫院診斷出罹患C型肝炎、肝癌、肝硬化、食道靜脈曲張及腹水等症狀,阿底爾的身體狀況每下愈況。起初,他的大兒子穆罕默德(Mohamad Adel Abdelgalel Abdalla)先在當地諮詢可能治癒父親的方法,並完成移植相關配對檢查。由於穆罕默德本身為耳鼻喉科醫師,他從老師的口中聽聞台灣長庚醫療水準相當好,於是決定來台進修,他也比較台灣、埃及的醫療發展,發現台灣醫療發展先進,肝臟移植技術冠全球,因而決定讓父親來台接受肝臟移植,他也將捐出右肝救父。為求此行萬無一失,穆罕默德與台灣活體肝臟移植權威之一-林口長庚醫院肝臟暨移植外科主任李威震多次溝通,國際醫療中心也主動協助他此次醫療之行,辦理醫療簽證及來台就醫事宜。

陪伴阿底爾來台的小兒子阿赫瑪德(Ahmad Adel Abdelgalel Abdalla)對林口長庚醫院的醫術和服務讚不絕口,除了感謝醫護人員,也對醫院設有伊斯蘭祈禱室感到驚訝,甚至親自至台北清真寺索取伊斯蘭簡介,放在祈禱室內供來院的穆斯林病患閱讀。

收治阿底爾的林口長庚醫院肝臟暨移植外科主任李威震說,個案因肝癌、肝硬化併發食道靜脈曲張及腹水,食道靜脈曲張嚴重時會破裂而導致大量出血;腹水則會造成腹脹不適、自發性細菌性腹膜炎,引起嚴重腹痛及發燒,也會導致肝昏迷,情況十分嚴峻,儘管個案曾於埃及進行四次輔助性的經導管動脈化學藥物栓塞治療(T.A.C.E),肝臟移植卻是唯一能同時治療肝癌、肝硬化並讓個案存活的選項。李威震主任表示,個案術後身體狀況恢復良好,一週便轉至普通病房,後續僅需在當地定期追蹤檢查。

阿底爾此次台灣醫療之行成果豐碩,順利完成肝臟移植。最後一次回診時,阿底爾身體狀況相當穩定,隔天便返回埃及,臨行之前仍不忘感謝李威震主任、長庚醫療團隊及國際醫療中心所給予的協助,也熱情邀約李威震主任等人有空到埃及旅遊,也希望埃及同胞都能夠到台灣接受專業優質的醫療照護。

1.親屬捐贈移植需要做那些檢查?

捐贈者及受贈者需抽血進行組織交叉配對。另捐贈者必須抽血做一般的血液及生化檢驗,包含血紅素、血小板、白血球、凝血功能、肝腎功能、電解質、病毒檢驗等。影像檢查則需要胸部X光、心電圖、心臟超音波、肺功能、電腦斷層及核磁共振等。除此之外,捐贈者及受贈者都需要接受精神科醫師及社工師進行心理及社會全面的評估。

2.捐贈者需要捐出多少的肝臟?

肝臟雖為一整個器官,但醫療上會依血管位置分為右肝與左肝。一般人來說,右肝比較大(佔全肝的50-60%以上),左肝比較小,兩側的肝臟功能都是相同的。而捐贈右肝或左肝,則是以受贈者的體重來決定。通常成年人捐贈給成年人,多數捐贈右肝。成年人捐贈給小孩或體重較輕的成年人,捐贈左肝就足夠。

3.捐贈者與受贈者不同血型可以嗎?

一般來說,如果有血型相容的捐贈者是最好的。O型的受贈者可接受O型捐贈者。A型的受贈者可以接受A型或O型的捐贈者。B型的受贈者可以接受B型或O型的捐贈者。AB型的受贈者則可接受全部血型的捐贈者。但本院在血型不相容的移植上已相當完備成熟,所以不同血型的移植在本院都可執行,只是相對於血型相容的移植病患,須在手術前必須進行一些醫療處置後才能執行手術。

4.捐贈者檢查流程需要多久?

捐贈者的檢查時間通常與移植團隊聯絡約定時間,但病情緊急的病人捐贈者最快可在1-2天內完成。

5.捐贈者手術會有那些風險?

根據文獻統計,捐贈者有千分之三的死亡率,但本院目前並無捐贈者死亡的案例。手術中的風險則有感染、出血、腸阻塞、腸沾黏及膽汁滲漏之合併症產生。另外因膽囊位置介於左右肝之間,故不論捐贈左肝或右肝,膽囊都會切除。

6.捐贈者及受贈者手術時間需要多久?

受贈者約需12至16小時。捐贈者需要6-8小時。

7.受贈者及捐贈者住院天數需要多久?

受贈者需在手術前4至5天先住院進行手術前最後評估,手術的前晚住進移植加護病房。手術後依病情變化,住1至3週加護病房,狀況穩定後則轉至一般隔離病房約1-3周恢復。捐贈者則在手術前一天住院,手術當天住一晚加護病房觀察,狀況穩定即可轉至普通病房恢復,平均總住院天數約7至10天。

8.捐贈者需要回診嗎?

捐贈者在出院後第一週需回診評估傷口等恢復狀況。後續則在手術後第一個月、第六個月及第十二個月都需回診進行抽血及電腦斷層的檢驗檢查,以評估身體恢復狀況。

  1. Wong CS, Lee WC, Jeng CC, Tian YC, Chang MY, Lin CY, Fang JT, Yang CW, Tsai MH, Shih HC, Chen YC. Scoring Short-Term Mortality After Liver Transplantation. Liver Transplantation 2010;16:138-146.
  2. Lee WC, Wu TJ, Chou HS, Lee CF, Chan KM, Cheng SS. Flexible and individualized treatment to achieve sustained viral response for recurrent hepatitis C in liver transplant recipients. J Viral Hepat. 2010;17:770-777.
  3. Lee WC, Lee CS, Soong RS, Lee CF, Wu TJ, Chou HS, Chan KM. Split liver transplantation in adults: Preoperative estimation of the weight of right and left hemiliver grafts.Liver Transpl. 2011;17(1):93-94.
  4. Lee WC, Chou HS, Wu TJ, Lee CS, Lee CF, Chan KM. Indicators and outcome of liver transplantation in acute liver decompensation after flares of hepatitis B. J Viral Hepat. 2011;18:193-199.
  5. Dahiya D, Lee CF, Chan KM, Wu TJ, Chou HS, Cheng SS, Lee WC. A short-term preemptive treatment for cytomegalovirus infection in seropositive patients after liver transplantation. J Hepatobiliary Pancreat Sci. 2011;18:32-38.
  6. Chan KM, Lee CS, Wu TJ, Lee CF, Chen TC, Lee WC*. Clinical perspective of  acute humoral rejection after blood type-compatible liver transplantation. Transplantation. 2011;15:91(5):e29-30.
  7. Frank Wang, Pan KT, Chu SY, Chan KM, Chou HS, Wu TJ, Lee WC*. Preoperative Estimation of the Liver Graft Weight in Adult Right Lobe Living Donor Liver Transplantation Using Maximal Portal Vein Diameters. LIVER TRANSPLANTATION. 2011;17:373-380.
  8. Chan KM, Yu MC, Chou HS, Wu TJ, Lee CF, Lee WC*. Significance of Tumor Necrosis for Outcome of Patients with Hepatocellular Carcinoma Receiving Locoregional Therapy Prior to Liver Transplantation. Ann Surg Oncol. 2011;18:2638-2646.
  9. Weng LC, Huang HL, Wang YW, Chang CL, Tsai CH, Lee WC. Primary caregiver stress in caring for a living-related liver transplantation recipient during the postoperative stage. Journal of Advanced Nursing 2011;67(8):1749 -1757.
  10. Huang CT, Lin HC, Chang SC, Lee WC*. Pre-Operative Risk Factors Predict Post-Operative Respiratory Failure after Liver Transplantation. PLoS ONE. 2011;6:e22689.
  11. Wu TJ, Dahiya D, Lee CS, Lee CF, Chou HS, Chan KM, Lee WC*. Impact of portal venous hemodynamics on indices of liver function and graft regeneration after right lobe living donor liver transplantation. Liver Transplantation. 2011;17:1035 -1045.
  12. Chan KM, Chou HS, Wu TJ, Lee CF, Yu MC, Lee WC*. Characterization of Hepatocellular carcinoma recurrence after liver transplantation: Perioperative prognostic factors, patterns, and outcome. Asian Journal of Surgery. 2011; 34:128-134.
  13. Wu TJ, Chen TC, Wang F, Chan KM, Soong RS, Chou HS, Lee WC*, Yeh CT*. Large fragment pre-s deletion and high viral load independently predict hepatitis B relapse after liver transplantation. PLoS One. 2012;7(2):e32189.
  14. Tsai YF, Liu FC, Lin CC, Lee WC, Yu HP. Tying a Slipknot to an Intubation Stylet for Facilitating Insertion of a Nasogastric Tube in Liver Transplant Recipients: A Prospective, Randomized Study. Transplantation Proceedings. 2012; 44:438–441.
  15. Tsai YF, Su BC, Lin CC, Liu FC, Lee WC, Yu HP. Cardiac Output Derived From Arterial Pressure Waveform Analysis: Validation of the Third-Generation Software in Patients Undergoing Orthotopic Liver Transplantation. Transplantation Proceedings. 2012; 44:433–437.
  16. Tsai YF, Lin CC, Lee WC, Yu HP. Propofol Attenuates Ischemic Reperfusion–Induced Formation of Lipid Peroxides in Liver Transplant Recipients. Transplantation Proceedings. 2012; 44:376–379.
  17. Lee CF, Eldeen FZ, Chan KM, Wu TH, Soong RS, Wu TJ, Chou HS, Lee WC*. Bortezomib Is Effective to Treat Acute Humoral Rejection After Liver Transplantation. Transplantation Proceedings.2012; 44: 529–531.
  18. Cheng CH, Lee CF, Soong RS, Wu TH, Chan KM, Chou HS, Wu TJ, Yu MC, Lee WC*. Risk Factors and Clinical Outcomes of Ventilator-Associated Pneumonia in Patients on the Liver Transplant Waiting List. Transplantation Proceedings.2012; 44: 762–764.
  19. Soong RS, Chan KM, Chou HS, Wu TJ, Lee CF, Wu TH, Lee WC*. The Risk Factors for Early Infection in Adult Living Donor Liver Transplantation Recipients. Transplantation Proceedings.2012; 44: 784–786.
  20. Wang YC, Wu TJ, Wu TH, Lee CF, Chou HS, Chan KM, Lee WC*. The Risk Factors to Predict Acute Rejection in Liver Transplantation. Transplantation Proceedings.2012; 44: 526–528.
  21. Weng LC, Chen HC, Huang HL, Wang YW, Lee WC. Change in the type of work of postoperative liver transplant patients. Transplant Proc. 2012;44(2):544-547.
  22. Weng LC, Huang HL, Wang YW, Chang CL, Tsai CH, Lee WC. The coping experience of Taiwanese male donors in living donor liver transplantation. Nurs Res. 2012; 61(2): 133-139.
  23. Lee WC, Chan KM, Chou HS, Wu TJ, Lee CF, Soong RS, Wu TH, Lee CS. Feasibility of split liver transplantation for 2 adults in the model of end-stage liver disease era. Ann Surg. 2013; 258(2):306-311.
  24. Wu TJ, Chan KM, Chou HS, Lee CF, Wu TH, Chen TC, Yeh CT, Lee WC. Liver transplantation in patients with hepatitis B virus-related hepatocellular carcinoma: the influence of viral characteristics on clinical outcome. Ann Surg Oncol. 2013;20(11): 3582-3590.
  25. Chan KM, Lee WC*. The Concerns of ‘‘Left at Right’’ Adult Liver Transplantation. American Journal of Transplantation 2013;13: 2777-2778.
  26. Lee WC. Pharmacotherapy of Small-for-Size of the Liver. Transplantation; 2014; 97(9): 890-891.
  27. Thorat A, Chou HS, Lee CF, Soong RS, Wu TH, Cheng CH, Wu TJ, Chan KM, Lee WC*. Effects of converting tacrolimus formulation from twice-daily to once-daily in liver transplantation recipients. BioMed Research International. 2014;2014:1-7.
  28. Lee WC, Wu TH, Cheng CH, Wu TJ, Chou HS, Chan KM. Ligation of the proximal splenic vein to overcome the effects of a large splenorenal shunt during living donor liver transplantation. Liver Transplantation. 2014;20(11):1420-1422.
  29. Thorat A, Lee CF, Wu TH, Pan KT, Chu SY, Chou HS, Chan KM, Wu TJ, Lee WC. Endovascular treatment for pseudoaneurysms arising from the hepatic artery after liver transplantation. Asian J Surg. 2014 Aug 30.
  30. Tsai YF, Liu FC, Sung WC, Lin CC, Chung PC, Lee WC, Yu HP. Ischemic reperfusion injury-induced oxidative stress and pro-inflammatory mediators in liver transplantation recipients. Transplant Proc. 2014 May;46(4):1082-6.
  31. Sung WC, Yu HP, Tsai YF, Chung PC, Lin CC, Lee WC. The ratio of plasma interleukin-18 is a sensitive biomarker for acute kidney injury after liver transplantation. Transplant Proc. 2014 Apr;46(3):816-7.
  32. Lee WC, Lee CF, Cheng CH, Wu TJ, Chou HS, Wu TH, Soong RS, Chan KM, Yu MC, Chen MF. Outcomes of liver resection for hepatocellular carcinoma in liver transplantation era. Eur J Surg Oncol. 2015 Sep;41(9):1144-52.
  33. Lee CF, Cheng CH, Wang YC, Soong RS, Wu TH, Chou HS, Wu TJ, Chan KM, Lee CS, Lee WC. Adult Living Donor Liver Transplantation Across ABO-Incompatibility. Medicine (Baltimore). 2015 Oct;94(42):e1796.
  34. Lee WC. Surgical treatment for hepatocellular carcinoma-choose liver resection or liver transplantation. Clinics in surgery 2016;12:1198-1202.
  35. Chen YC, Huang TS, Wang YC, Cheng CH, Lee CF, Wu TJ, Chou HS, Chan KM, Lee WC, Soong RS. Effect of Prophylactic Antifungal Protocols on the Prognosis of Liver Transplantation: A Propensity Score Matching and Multistate Model Approach. BioMed Research International. 2016 August,1-7. doi: 10.1155/2016/6212503.
  36. Chen YC, Cheng CH, Wang YC, Wu TJ, Chou HS, Chan KM, Lee WC, Lee CF, Soong RS. Betel quid chewing leads to the development of unique de novo malignancies in liver transplant recipients, a retrospective single center study in Taiwan. Medicine (Baltimore). 2016 August;95(37):e4901.
  37. Lee WC, Lee CS, Wang YC, Cheng CH, Wu TH, Lee CF, Song RS, Chang ML, Wu TJ, Chou HS, Chan KM. Validation of the Model for End-Stage Liver Disease Score Criteria in Urgent Liver Transplantation for Acute Flare Up of Hepatitis B. Medicine (Baltimore). 2016, 95(2): e3609.
  38. Lee YJ, Wang YL, Lee WC, Wu SH, Lin CY, Lee SJ, Chen YC, Hung CJ, Yang CH, Ten YC. The association between polyomavirus BK strains and BKV viruria in liver transplant recipients. Scientific reports 2016;32:165-176.
  39. Pan HC, Chen YJ, Lin JP, Tsai MJ, Jenq CC, Lee WC, Tsai MH, Fan PC, Chang CH, Chang MY, Tian YC, Hung CC, Fang JT, Yang CW, Chen YC. Proteinuria can predict prognosis after liver transplantation. BMC Surg. 2016 Sep;16(1):1-12.
  40. Lee HC, Tsai YF, Tsai SY, Chung CH, Yu HP, Lee WC, Lin JC. Pulse oximeter-derived pleth variability index is a reliable indicator of cardiac preload in patients undergoing liver transplantation. Transplantation Proceedings 2016; 48: 1055-1058.
  41. Huang PH, Shih BF, Tsai YF, Chung PC, Liu FC, Yu HP, Lee WC, Chang CJ, Lin CC. Accuracy and Trending of Continuous Noninvasive Hemoglobin Monitoring in Patients Undergoing Liver Transplantation. Transplant Proc. 2016 May; 48(4):1067-1070.
  42. Lee CF, Wang YC, Cheng CH, Wu TH, Chen YC, Soong RS, Wu TJ, Chou HS, Chan KM, Lee WC. Application of CD8+ cells count as a guide immunosuppressive regimen introduction for very sick patients undergoing liver transplantation. Transplantation Proceedings. 2016;48:3356-3361.
  43. Lee CF, Lu CY, Zidan A, Lee CS, Wu TH, Chan KM, Lee WC*. Microscope-assisted hepatic artery reconstruction in adult living donor liver transplantation-a review of 325 consecutive cases in a single center. Clinical Transplantation. 2017; Feb;31(2), e12879.
  44. Abdelhamid NM, Chen YC, Wang YC, Cheng CH, Wu TJ, Lee CF, Wu TH, Chou HS, Chan KM, Lee WC, Soong RS*. Pre-Transplantation Immune Cell Distribution and Early Post-Transplant Fungal Infection Are the Main Risk Factors of Liver Transplantation Recipients in Lower Model of End-Stage Liver Disease. Transplantation Proceedings. 2017;49(1):92-97.
  45. Weng LC, Huang HL, Tsai HH, Lee WC. Predictors of decision ambivalence and the differences between actual living liver donors and potential living liver donors. PLOS ONE https://doi.org/10.1371/journal.pone.0175672 May 17, 2017.
  46. Lee WC*, Wu TH, Wang YC, Cheng CH, Lee CF, Wu TJ, Chou HS, Chan KM, Lee CS. Renal Function Improvement by Telbivudine in Liver Transplant Recipients with Chronic Kidney Disease. BioMed Research International. 2017; August. doi.org/ 10.1155/ 2017/ 9324310.
  47. Lee JC, Doush WMA, Wang YC, Cheng CH, Wu TH, Chen YC, Soong RS, Wu TJ, Chou HS, Chan KM, Lee WC, Lee CF. Prognostic impact and risk factors of low body mass index in patients undergoing liver transplantation. Clin Transplant. 2017 Sep;31(9),e1304.
  48. Jeng LB, Lee SG, Soin AS, Lee WC, Suh KS, Joo DJ, Uemoto S, Joh J, Yoshizumi T, Yang HR, Song GW, Lopez P, Kochuparampil J, Sips C, Kaneko S, Levy G. Efficacy and safety of everolimus with reduced tacrolimus in living-donor liver transplant recipients: 12-month results of a randomized multicenter study. Am J Transplant. 2018;18:1435–1446.
  49. Lee WC, Chou HS, Lee CS, Wu TH, Wang YC, Cheng CH, Lee CF, Wu TJ, Chan KM. Viral activity and outcome of hepatitis B surface antigen-positive grafts in deceased liver transplantation. J Viral Hepat. 2018;1-4.