Hashimoto Takuya, Miki Kenji, Imamura Hiroshi, Sano Keiji, Satou Shoichi, Sugawara Yasuhiko, Kokudo Norihiro, Makuuchi Masatoshi
Artificial Organ and Transplantation Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
Liver Transpl. 2008 Jun;14(6):872-80. doi: 10.1002/lt.21460.
Split liver transplantation and living donor liver transplantation (LDLT) commonly use a right liver graft without the middle hepatic vein (MHV). Although tributaries of the MHV are not reconstructed in the majority of cases, the alterations of the microcirculation and its regional functions remain unknown. We addressed these issues by assessing liver tissue indocyanine green (ICG) uptake with near-infrared spectroscopy (NIRS) in 21 donors. After graft procurement, visual inspection (before and after hepatic arterial clamping) and Doppler examination of the veno-occlusive region were performed. Bolus ICG (100 microg/kg) was then administered intravenously. Blood ICG at the finger tip was measured with pulse dye densitometry, whereas the liver ICG concentrations in the veno-occlusive and non-veno-occlusive regions were simultaneously measured for 15 minutes by NIRS. We estimated the hepatic ICG uptake rate constants in the veno-occlusive region (Ku-oc) and non-veno-occlusive region (Ku-non). Changes in sinusoidal perfusion in the veno-occlusive region were expressed by the ratio of Ku-oc to Ku-non (Roc/non). The median value of Roc/non was 0.47, although it ranged from 0.13 to 0.94. Roc/non was related to the extent of liver surface discoloration before and after hepatic arterial clamping (P = 0.03 and 0.01, respectively). In conclusion, sinusoidal perfusion was impaired in the veno-occlusive regions of living donor livers, but the magnitude of the effect varied greatly. Measurement of hepatic ICG uptake by NIRS could become a valuable tool for assessing the indication for venous reconstruction in LDLT and/or split donor liver transplantation.
劈离式肝移植和活体供肝肝移植（LDLT）通常采用不带肝中静脉（MHV）的右肝移植物。尽管大多数情况下不重建MHV的属支，但微循环的改变及其区域功能仍不清楚。我们通过对21例供体肝脏组织采用近红外光谱（NIRS）评估吲哚菁绿（ICG）摄取来解决这些问题。在获取移植物后，进行肉眼检查（肝动脉阻断前后）和静脉闭塞区域的多普勒检查。然后静脉推注ICG（100μg/kg）。用脉冲染料密度测定法测量指尖的血液ICG，而通过NIRS同时测量静脉闭塞和非静脉闭塞区域的肝脏ICG浓度15分钟。我们估计了静脉闭塞区域（Ku-oc）和非静脉闭塞区域（Ku-non）的肝脏ICG摄取速率常数。静脉闭塞区域的肝血窦灌注变化用Ku-oc与Ku-non的比值（Roc/non）表示。Roc/non的中位数为0.47，范围为0.13至0.94。Roc/non与肝动脉阻断前后肝脏表面变色程度相关（分别为P = 0.03和0.01）。总之，活体供肝静脉闭塞区域的肝血窦灌注受损，但影响程度差异很大。通过NIRS测量肝脏ICG摄取可能成为评估LDLT和/或劈离式供肝移植中静脉重建指征的有价值工具。
