Cui D, Kiuchi T, Egawa H, Hayashi M, Sakamoto S, Ueda M, Kaihara S, Uemoto S, Inomata Y, Tanaka K
Department of Transplantation and Immunology, Kyoto University Faculty of Medicine, 54 Kawara-cho, Shogoin, Sakyo-ku Kyoto 606-8507, Japan.
Transplantation. 2001 Jul 27;72(2):291-5. doi: 10.1097/00007890-200107270-00022.
A continuing shortage of cadaveric liver even for adult patients has motivated not a few centers to proceed to living-donor liver transplantation using right lobe grafts. One of controversies is potential congestion in the graft anterior segment by the deprivation of the middle hepatic vein.
Hepatic tissue oxygenation and hemoglobin concentration were investigated with a near-infrared spectroscopy in the course of harvesting and implantation in living-donor liver transplantation. Twenty adult recipients of right lobe graft were involved in the study. The aim of the analysis was to detect tissue congestion or ischemia.
No significant change in mean hepatic tissue oxygenation and hemoglobin was noted in the right lobe during donor operation even after hepatic parenchymal transection, although some trend for relative congestion, i.e., increased tissue hemoglobin, compared with the left lobe was observed. After graft reperfusion in the recipient, both mean hepatic tissue oxygen saturation and hemoglobin decreased significantly in the anterior segment, which was accompanied by increased heterogeneity of tissue hemoglobin and oxygenation. Increased heterogeneity of oxygenation and decreased tissue hemoglobin were observed also in the posterior segment.
The anterior segment in right lobe living-donor liver transplantation is sensitive to ischemia, rather than congestion, at least in the immediate phase after graft reperfusion. The anterior segment seems to be also more prone to circulatory disturbance than the other part of the graft.
即使对于成年患者，尸体肝脏的持续短缺也促使不少中心采用右叶移植物进行活体肝移植。争议之一是肝中静脉缺失导致移植物前段潜在的充血。
在活体肝移植的获取和植入过程中，使用近红外光谱法研究肝组织氧合和血红蛋白浓度。20名接受右叶移植物的成年受者参与了该研究。分析目的是检测组织充血或缺血情况。
在供体手术期间，即使在肝实质横断后，右叶的平均肝组织氧合和血红蛋白也无显著变化，尽管与左叶相比观察到相对充血的一些趋势，即组织血红蛋白增加。在受者移植物再灌注后，前段的平均肝组织氧饱和度和血红蛋白均显著下降，同时伴有组织血红蛋白和氧合的异质性增加。在后段也观察到氧合异质性增加和组织血红蛋白下降。
至少在移植物再灌注后的即刻阶段，右叶活体肝移植的前段对缺血敏感，而非充血。与移植物的其他部分相比，前段似乎也更容易发生循环障碍。
