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

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  • Treatment strategy for small-for-size graft in living donor liver transplantation
  • セイタイ カンイショク ニオケル カショウ グラフト ノ ビョウタイ セイリ ト チリョウ センリャク

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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.

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