Sauvanet A, Yang S, Bernuau D, Beyne P, Denninger M H, Farges O, Lebrec D, Belghiti J
Department of Digestive Surgery, Hôpital Beaujon, Clichy, France.
Transpl Int. 1999;12(6):433-8. doi: 10.1007/s001470050254.
The technical factors which could influence regeneration of the native liver (NL) in auxiliary liver transplantation (ALT) for fulminant hepatic failure (FHF) are not well known. We studied NL regeneration according to the location of graft anastomosis in the recipient's portal system (superior mesenteric vein versus portal vein), and graft weight (50% reduced-size versus full-size graft) in a rat model of ALT with 80% reduction of the NL, and graft arterialization. NL regeneration was significantly more obvious when the graft was anastomosed on the recipient's superior mesenteric vein, thus establishing venous flow to the NL from the pancreas, the spleen, and the stomach, and when a full-size graft was used. The influence of portal venous flow on NL regeneration, assessed by 3H[-thymidine incorporation, was measurable as early as day 2. Both technical variables in combination resulted in significantly greater regeneration (ratio weight of NL/body weight at day 30: 2.32 +/- 0.68% versus 1.21 +/- 0.63% respectively, P = 0.02). Early preservation of portal flow to the NL is advisable to maximize NL regeneration in ALT. In any case, this regeneration is not impeded by the use of large auxiliary grafts.
在暴发性肝衰竭（FHF）的辅助性肝移植（ALT）中，影响自体肝（NL）再生的技术因素尚不明确。我们在NL体积缩小80%的ALT大鼠模型中，根据移植肝在受体门静脉系统中的吻合位置（肠系膜上静脉与门静脉）、移植肝重量（减体积50%与全尺寸移植肝）以及移植肝动脉化情况，研究了NL的再生情况。当移植肝吻合于受体的肠系膜上静脉从而建立起从胰腺、脾脏和胃到NL的静脉血流时，以及当使用全尺寸移植肝时，NL的再生明显更显著。通过3H - 胸腺嘧啶核苷掺入评估的门静脉血流对NL再生的影响，早在第2天就可检测到。这两个技术变量共同作用导致再生显著增强（第30天NL重量/体重比分别为2.32±0.68%和1.21±0.63%，P = 0.02）。建议早期保留NL的门静脉血流以在ALT中使NL再生最大化。无论如何，使用大型辅助移植肝并不会阻碍这种再生。
