Living donor liver transplantation Pre-transplant report VS: Teng-Wei Chen R3: Hung-Yi Yang

General data Donor Recipient Name:林x婷 Name:林x霞 ID: 2943676 ID: 2942325 Age: 48 Gender: F Admission date: 2017/02/19 Operation date: 2016/12/20 Donor Name:林x婷 ID: 2943676 Age: 23 Gender: F Admission date: 2017/02/19 Operation date: 2016/12/20 Relationship: 母女

Present illness Chronic hepatitis B was noted by prenatal examination 20 years ago Chronic hepatitis B was noted by prenatal examination Elevated liver function by healthy examination SBP, low leg edema, hyperbilirubemia → Diuretics + antibiotic + Viread Hepatic encephalopathy, acute kidney injury 2015 Nov. 2016/9/8 2016/10/23

Present illnes hepatic encephalopathy re-admission 2016/10/29 hepatic encephalopathy re-admission Liver transplant evaluation 2016/11/01

Past and personal history History of systemic disease: Nil History of major operation: Rib fracture s/p repair. Chondromalacia patella s/p. Denied allergy to food or drugs Habit of smoking: denied Alcohol drinking: Beer and 高粱酒 for 20 years, quit since 2016 January. Occupation: Nil

Physical examination BH: 156 cm, BW: 43 Kg, BP: 102/56 mmHg, HR: 76/min, RR:18/min, BT: 36.4 C Conscious: alert, Mentality: intact to JOMAC, GCS: E4M6V5 Skin: jaundice, no skin rash, no ecchymosis. HENNT: ictera sclera, anemic conjunctiva; no gum bleeding. no palpable neck nodes Chest: no rhonchi, no decreased breathing sound. Heart: Regular heart beats; no murmurs Abdomen: soft and flat in shape; no tenderness; normal bowel sound. Extremities: no pitting edema , no limitation of motion, no peripheral cyanosis. Nervous system: no impairment of motor or sensory function

Serologic examinations B/R SMA Tumor markers Virology study WBC 3,020 BUN 31 AFP 11.95 HBsAg + Hb 11.3 Cr 1.2 CA-199 14.82 HBsAb - Plt 51,000 AST 83 HBeAg PT 12.2 ALT 56 HBeAb PTT 28.7 T. Bil 4.6 Others HBcAb INR D. Bil 1.6 PAP 38 mmHg Anti-HCV Alb 3.2 EF 64% CMV IgG NH3 137 FEV1/FVC 67% HIV Ab/Ag r-GT 46 HSV IgG EBV IgG RPR NR Criteria 1 point 2 points 3 points Bilirubin (mg/l) <2 2-3 >3 Albumin (g/l) >3.5 2.8-3.5 <2.8 INR <1.7 1.7-2.2 >2.2 Ascites Nil Controlled Poor control Encephalopathy Child C

2016.11.02 WITHOUT CONTRAST MRI-ABDOMEN The liver shows irregular contour with splenomegaly and moderate ascites, cirrhosis of liver with portal hypertension.

Tentative diagnosis HBV and Alcohol related liver cirrhosis complicated with hepatic encephalopathy (2016-10.23 and 2016-10.29), moderate ascites, portal hypertension, splenomegaly, anemia, thrombocytopenia, hyperbilirubinemia, hypoalbuminemia and hyperammonemia. Child C (11)[MELD SCORE=15].

General data Donor Recipient Name:林x婷 Name:林x霞 ID: 2943676 ID: 2942325 Age: 48 Gender: F Admission date: 2017/02/19 Operation date: 2016/12/20 Donor Name:林x婷 ID: 2943676 Age: 23 Gender: F Admission date: 2017/02/19 Operation date: 2016/12/20 Relationship: 母女

Donor Past & Personal history: Hx of systemic disease: nil History of major operation: nil. Hx of smoking: nil. Hx of drinking: nil. 5. Occupation: STUDENT. Physical examination BH/BW: 154 cm/45 kg; others not remarkable

Serologic examination B/R SMA Tumor markers Virology study WBC 6,870 BUN 10 AFP 1.7 HBsAg - Hb 13.1 Cr 0.7 CA-199 NA HBsAb Plt 173,000 AST 17 CEA HBeAg PT 10.0 ALT 8 HBeAb PTT 26.2 T. Bil 0.5 Others HBcAb INR 0.9 D. Bil 0.1 Anti-HCV Alb 4.6 CMV IgG NH3 52 HIV Ab/Ag r-GT HSV IgG TC 192 EBV IgG + TG 96 RPR NR

Donor-recipient-match profile Gender F Blood type A+ O+ Body height/weight 156/43 154/45 HLA-ABC A2,A24,B48,Bw6,Cw8 A2,A24,B62,B48,Bw6,Cw7,Cw8 HLA-DR DR8,DR14,DR52 DR7,DR8,DR53 HLA-DQ DQ6,DQ5 DQ2,DQ6 Kinship Mother Daughter

Liver : Spleen =1.1 說明：肝臟與脾臟比值，如比值大於1.0 ，表示正常

Hepatic Artery

Hepatic Vein

Portal Vein

Bile Duct

總結 捐贈者為健康之女性，右肝捐贈 捐贈者肝臟：878公克，捐贈456公克肝臟，約其肝臟52%，保留382公克。 受贈者：最少需要之肝臟體積為其體重0.8% 此次受贈肝臟約其體重1.0%