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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Author(s)

    • 島田 光生 Shimada Mitsuo
    • 徳島大学器官病態修復医学講座臓器病態外科分野 Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School
    • 副島 雄二 Soejima Yuji
    • 徳島大学器官病態修復医学講座臓器病態外科分野 Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School
    • 藤井 正彦 [他] FujiiMasahiko
    • 徳島大学器官病態修復医学講座臓器病態外科分野 Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School

Abstract

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.

Journal

  • Shikoku acta medica

    Shikoku acta medica 62(1・2), 30-37, 2006-04-25

    The University of Tokushima

Codes

  • NII Article ID (NAID)
    110006284502
  • NII NACSIS-CAT ID (NCID)
    AN00102041
  • Text Lang
    JPN
  • Article Type
    journal article
  • Journal Type
    大学紀要
  • ISSN
    00373699
  • NDL Article ID
    7957231
  • NDL Source Classification
    ZS7(科学技術--医学)
  • NDL Call No.
    Z19-344
  • Data Source
    NDL  NII-ELS  IR 
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