Chen Hui-Xing, Zhou Guang-Wen, Yin Lu, Peng Cheng-Hong, Li Hong-Wei
Center of Organ Transplantation, Ruijin Hospital, Shanghai Second Medical University, Shanghai 200025, China.
Hepatobiliary Pancreat Dis Int. 2005 Nov;4(4):519-23.
The number of split liver transplantations (SLT) has increased in the last 5 years. Regeneration after the loss of hepatic tissue is a fundamental response to liver injury. Because partial-liver grafts may not be an optimal size for recipients,the purpose of this study was to investigate the regeneration of graft liver after SLT.
Four recipients have undergone SLT at our hospital since 2002. The graft liver volume (GLV) in the postoperative day (POD) was measured by computed tomography (CT) and the serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TB), prealbumin (PA) and albumin (ALB) were monitored. The GLV at different postoperative times was compared to the recipient's standard liver volume (SLV) and the liver volume regeneration ratio (LVRR) was calculated. In order to compare SLV in recipient 2, we measured the total liver volume including the graft and the residual native liver as the GLV.
The GLV/SLV at POD120 and POD360 of recipient 1 was measured 114% (1159.32 cm(3)/1016.95 cm(3)), 97% (986.44 cm(3)/1016.95 cm(3)) with the LVRR being -11.0%, -24.3%, respectively. For recipient 2, it was measured 96% (927.32 cm(3)/965.96 cm(3)) and 100% (968.98 cm(3)/965.96 cm(3)), with the LVRR being 24.4%, 30.0%, respectively. The initial graft volume of segment II, III was 265.36 cm(3) and increased to 335.24 cm(3) and 360.56 cm(3) at POD120 and POD360, respectively, with the LVRR being 26.3% and 35.9%, respectively. The GLV/SLV at POD60 of recipient 3 was 86% (893.04 cm(3)/1038.42 cm(3)) and the LVRR was 12.0%. For recipient 4, it was 90% (567.48 cm(3)/630.54 cm(3)) whereas the LVRR was 20.0%. The serum levels of ALT, AST and TB in all recipients declined gradually and returned to normal while the serum levels of PA and ALB increased to normal. The serum levels of ALT and AST peaked within 3 days after SLT. The neurological symptoms of Wilson's disease in recipient 2 were improved markedly. The levels of serum copper and copper-protein decreased to 30 mg/L, 120 mg/L at POD120 and the Kayser-Fleischer rings began to obliterate.
The size of the transplanted liver after SLT tends to converge to the standard liver volume with time and it is adequate clinically for SLT to meet the need of the body's metabolic demands. The functional recovery of the graft liver occurs earlier than the morphological restoration.
在过去5年中，劈离式肝移植（SLT）的数量有所增加。肝组织损失后的再生是对肝损伤的一种基本反应。由于部分肝移植物对于受者来说可能不是最佳大小，本研究的目的是调查SLT后移植肝的再生情况。
自2002年以来，我院有4例受者接受了SLT。术后通过计算机断层扫描（CT）测量移植肝体积（GLV），并监测血清天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、总胆红素（TB）、前白蛋白（PA）和白蛋白（ALB）水平。将不同术后时间的GLV与受者的标准肝体积（SLV）进行比较，并计算肝体积再生率（LVRR）。为了比较受者2的SLV，我们测量了包括移植物和残余天然肝在内的全肝体积作为GLV。
受者1术后120天和360天的GLV/SLV分别为114%（1159.32 cm³/1016.95 cm³）、97%（986.44 cm³/1016.95 cm³），LVRR分别为-11.0%、-24.3%。受者2的GLV/SLV分别为96%（927.32 cm³/965.96 cm³）和100%（968.98 cm³/965.96 cm³），LVRR分别为24.4%、30.0%。第II、III段的初始移植物体积为265.36 cm³，在术后120天和360天分别增加到335.24 cm³和360.56 cm³，LVRR分别为26.3%和35.9%。受者3术后60天的GLV/SLV为86%（893.04 cm³/1038.42 cm³），LVRR为12.0%。受者4的GLV/SLV为90%（567.48 cm³/630.54 cm³），LVRR为20.0%。所有受者的血清ALT、AST和TB水平逐渐下降并恢复正常，而血清PA和ALB水平则升高至正常。血清ALT和AST水平在SLT后第3天达到峰值。受者2威尔逊病（肝豆状核变性）的神经症状明显改善。术后120天血清铜和铜蛋白水平分别降至30 mg/L、120 mg/L，角膜K-F环开始消退。
SLT后移植肝的大小随时间趋于接近标准肝体积，从临床角度看，SLT足以满足机体代谢需求。移植肝功能的恢复早于形态学的恢复。
