生体肝移植における過小グラフトの病態生理と治療戦略 [in Japanese] Treatment strategy for small-for-size graft in living donor liver transplantation [in Japanese]
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Introduction : To save the small-for-size graft in living donor adult liver transplantation （LDALT）, it is necessary to overcome the following problems：１）excessive portal inflow；２）graft congestion；３）small functional liver mass ; and４）inadequate intragraft responses.Treatments for the small-for-size graft.１）To avoid excessive portal inflow（: a）Splenctomy or splenic artery ligation to reduce portal pressure and flow ; and b）Portocaval shunt to reduce portal pressure and flow.２）To avoid graft congestion : a）Graft venoplasty and graft hepatic vein to the IVC anastomosis in left lobe grafts, and reconstruction of significant venous tributaries from the middle hepatic vein in right lobe grafts ; and（b）Intraportal administration of drugs（PG-E１, etc.）to prevent microcirculatory disturbance.３）To avoid liver failure due to small functional liver mass : Hyperbaric oxygen therapy is a feasible option for a persistent functional hyperbiliruminemia.４）To modulate inadequate intragraft responses（: a）Induction of heat shock protein into the graft to suppress up-regulation of inflammatory cytokines, and to improved survival rate after ９５％-hepatectomy（Hx）in rats ; and（b）Slow-down of liver regeneration to reduce liver injury and to improve survival rate after９０％-Hx in rats.Conclusions : Pathophysiology-oriented strategy against small-for-size graft is effective in LDALT.
- Shikoku acta medica
Shikoku acta medica 62(1・2), 30-37, 2006-04-25
The University of Tokushima