生体肝移植の問題点―特に過小グラフト対策について―

Abstract

Background Recent advancement of liver transplantation technology and donor shortage has urged patients to have living donor liver transplantation. One of the issues is small-for-size graft syndrome, which is life-threatening with severe liver damage by excessively elevated portal pressure in an adult case and difficult to solve. Materials and Methods Twelve beagle dogs of about 1 year in age were randomly divided into Groups H (underwent 70% hepatectomy) and JH (70% hepatectomy after jejunectomy=50%proximal resection of the small intestine). Three dogs in each group were euthanized at 1 week after the operation and the remaining three dogs in each group at 4 weeks. We studied effects of the jejunectomy on the remnant liver after the massive hepatectomy with hemodynamic changes, liver functions, and liver histology. Results The portal pressure in Group JH (n=6) was significantly reduced one hour after the hepatectomy in comparison with that in Group A (n=6, p=0.002). Hepatic arterial flow was significantly higher in Group JH than in Group H (p=0.004). Subsequently, the total hepatic flow also rose to a higher value in Group JH than in Group A (p=0.037). Hepatic tissue flow was significantly higher in Group JH (p=0.025). On the earlier postoperative days, AST, ALT, ALB and AT3 of Group JH were significantly better than those of Group H. Histology of the remnant liver in the early phase showed significantly more swollen hepatocytes with subsequent more apoptotic cells in Group H than in Group JH. Conclusions Our results suggest that the portal pressure control by the jejunectomy can forestall liver dysfunction in small-for-size graft syndrome after living donor liver transplantation in adults.