Suehiro Taketoshi, Shimada Mitsuo, Kishikawa Keiji, Shimura Tatsuo, Soejima Yuji, Yoshizumi Tomoharu, Hashimoto Kohji, Mochida Yasushi, Hashimoto Shinji, Maehara Yoshihiko, Kuwano Hiroyuki
Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan.
Transpl Int. 2005 Aug;18(8):923-8. doi: 10.1111/j.1432-2277.2005.00159.x.
The most important problem in the living donor adult liver transplantation (LDALT) is a small for size graft. Although a right lobe graft is used in many cases in order to avoid small for size graft, for a donor, the risk has few in left lobe graft. We evaluate the effect of an intraportal infusion treatment to the small for size graft. One hundred and twelve patients who underwent LDALT were studied. The graft weight recipient standard liver volume ratio (GV/SLV) of these patients were 50% or less. We divided the patients into following two groups; infusion group (n = 53) and control group (n = 59). For the infusion group, 16 G double lumen catheter was inserted into portal vein and nafamostat mesilate (protease inhibitor which stabilize coagulofibrinolytic state; 200 mg/day), prostaglandin E(1) (vasodilator and hepatoprotective effect; 500 microg/day) and thromboxane A(2) synthetase inhibitor (vasodilator and anticoagulant effect; 160 mg/day) were administrated continuously for 7 days. Small-for-size graft syndrome was defined as bilirubin >10 mg/dl and ascites >1000 cc on postoperative day (POD) 14. Comparison examination of a background factors and postoperative bilirubin and amount of ascites was carried out. The mean GV/SLV did not have the difference at 39.1% of infusion group, and 38.3% of control group (P = 0.58). By the control group, 15 patients (25.4%) were small-for-size graft syndrome, however, there was only two (3.8%) small-for-size graft syndrome in infusion group (P = 0.04). The bilirubin levels of infusion and control group on 7 and 14 POD were 9.9 and 7.8 vs. 9.5 and 10.5 mg/dl, respectively. The amount of ascites of infusion group on 7 and 14 POD were 870 and 430 cc, respectively. On the contrary, in control group, the amount of ascites on 7 and 14 POD were 1290 and 1070 cc, respectively. Bilirubin levels and the amount of ascites on 7 and 14 POD were lower in the patients with infusion group then those with control group. There were no differences between infusion group and control group in age, sex and Child's classification. The intraportal infusion had an effect in prevention of hyperbilirubinemia and loss in quality of excessive ascites in the patients with small for size graft. This was suggested to be what is depended on the improvement of the microcirculation insufficiency considered one of the causes of small-for-size graft syndrome.
成人活体肝移植（LDALT）中最重要的问题是移植肝体积过小。尽管在许多情况下使用右叶移植肝以避免移植肝体积过小，但对于供体而言，左叶移植肝的风险较小。我们评估门静脉内输注治疗对移植肝体积过小的效果。对112例行LDALT的患者进行了研究。这些患者的移植肝重量与受体标准肝体积比（GV/SLV）为50%或更低。我们将患者分为以下两组：输注组（n = 53）和对照组（n = 59）。对于输注组，将16G双腔导管插入门静脉，并持续7天给予甲磺酸萘莫司他（一种稳定凝血纤溶状态的蛋白酶抑制剂；200mg/天）、前列腺素E（1）（一种血管扩张剂和具有肝保护作用；500μg/天）和血栓素A（2）合成酶抑制剂（一种血管扩张剂和抗凝剂；160mg/天）。小体积移植肝综合征定义为术后第14天胆红素>10mg/dl且腹水>1000cc。对背景因素以及术后胆红素和腹水量进行了比较检查。输注组的平均GV/SLV为39.1%，对照组为38.3%，两者无差异（P = 0.58）。对照组中有15例患者（25.4%）发生小体积移植肝综合征，而输注组仅有2例（3.8%）发生小体积移植肝综合征（P = 0.04）。输注组和对照组在术后第7天和第14天的胆红素水平分别为9.9和7.8mg/dl，以及9.5和10.5mg/dl。输注组在术后第7天和第14天的腹水量分别为870cc和430cc。相反，对照组在术后第7天和第14天的腹水量分别为1290cc和1070cc。输注组患者在术后第7天和第14天的胆红素水平和腹水量均低于对照组。输注组和对照组在年龄、性别和Child分级方面无差异。门静脉内输注对预防移植肝体积过小患者的高胆红素血症和减少过多腹水的产生有效果。这提示这取决于被认为是小体积移植肝综合征病因之一的微循环功能不全的改善。
