肝不全に対する外科的アプローチ : 徳島での生体肝移植の進捗と世界への発信のための新たな戦略

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  • Surgical approaches for liver failure : progress of living donor liver transplantation in Tokushima University Hospital and a new worldwide strategy from The Tokushima University
  • カンフゼン ニ タイスル ゲカテキ アプローチ : トクシマ デノ セイタイ カンイショク ノ シンチョク ト セカイ エノ ハッシン ノ タメ ノ アラタナ センリャク

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Abstract

I herein introduce a new surgical strategy against liver failure, which includes liver transplantation（especially living donor liver transplantation（LDLT））, splenectomy and artificial liver support system. I wan to emphasize progress of LDLT in Tokushima. Since restart of LDLT in February 2005, five consecutive cases have been done thanks to all staffs in Tokushima University Hospital. Surgical technique of LDLT is excellent, judging from intraoperative blood loss of both donors and recipients. Overall survival rate（80%）is satisfactory. In Japan, only 31 cases underwent liver transplantation from deceased（=brain-dead）donor since February 1999（below 5 cases per year）. This number is unbelievable when compared to USA（over 4,500 cases per year）. Under such abnormal circumstances, there are many patients with end-stage liver disease who can not under go LDLT due to no donor. Splenectomy is a promising modality for those patients, which brings improvement of hypersplenism（low platelet count and leukocyte count） liver function tests（bilirubin value and ICGR-15）,and nutritional state. Furthermore, liver regeneration is suggested to be promoted. Our new type of artificial liver support system using a photocatalystic effect of titanium is also a next-generation therapy for liver failure. In conclusions, a top-level LDLT became possible in Tokushima, however, increase in number of liver transplantation from deceased donor is a big and urgent problem. Splenectomy may be one of the most important modalities for liver-failured patients without any living donor. I am going to create original and high-quality therapeutic methods for liver failure as many as possible in order to send new information to all over the world as a center of liver-failure management institutions in Shikoku Island. Again, I appreciate all staffs in TheTokushima University Hospital regarding success in restart of LDLT.

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