右半肝切除术后活体供肝肝再生相关的功能元件。
Functional elements associated with hepatic regeneration in living donors after right hepatic lobectomy.
机构信息
Section of Hepatology, Division of Gastroenterology and Hepatology, University of Colorado Denver, Aurora, CO 80045, USA.
出版信息
Liver Transpl. 2013 Mar;19(3):292-304. doi: 10.1002/lt.23592.
We quantified the rates of hepatic regeneration and functional recovery for 6 months after right hepatic lobectomy in living donors for liver transplantation. Twelve donors were studied pre-donation (baseline); 8 were retested at a mean ± SD of 11±3 days after donation (T1), 10 were retested at a mean of 91±9 days after donation (T2), and 10 were retested at a mean of 185±17 days after donation (T3). Liver and spleen volumes were measured with computed tomography (CT) and single-photon emission computed tomography (SPECT). Hepatic metabolism was assessed with caffeine and erythromycin, and hepatic blood flow (HBF) was assessed with cholates, galactose, and the perfused hepatic mass (PHM) by SPECT. The regeneration rates (mL kg(-1) of body weight day(-1)) by CT were 0.60±0.22 mL from the baseline to T1, 0.05±0.02 mL from T1 to T2, and 0.01±0.01 from T2 to T3; by SPECT they were 0.54±0.20, 0.04±0.01, and 0.01±0.02, respectively. At T3, the liver volumes were 84%±7% of the baseline according to CT and 92%±13% of the baseline according to SPECT. Changes in the hepatic metabolism did not achieve statistical significance. At T1, the unadjusted clearance ratios with respect to the baseline were 0.75±0.07 for intravenous cholate (P<0.001), 0.88±0.15 for galactose (P=0.07), 0.84±0.08 for PHM (P=0.002), and 0.83±0.19 for the estimated HBF (P=0.06). At T1, these ratios adjusted per liter of liver were up to 50% greater than the baseline values, suggesting recruitment of HBF by the regenerating liver. Increased cholate shunt, increased spleen volume, and decreased platelet count, were consistent with an altered portal circulation. In conclusion, initial hepatic regeneration is rapid, accounts for nearly two-thirds of total regeneration, and is associated with increases in HBF and cholate uptake. Right lobe donation alters the portal circulation of living donors, but the long-term clinical consequences, if there are any, are unknown.
我们定量研究了活体肝移植供者右半肝切除术后 6 个月的肝再生和肝功能恢复速度。12 名供者在捐献前（基线）进行了研究；8 名供者在捐献后平均 11±3 天（T1）进行了重复测试，10 名供者在捐献后平均 91±9 天（T2）进行了重复测试，10 名供者在捐献后平均 185±17 天（T3）进行了重复测试。通过计算机断层扫描（CT）和单光子发射计算机断层扫描（SPECT）测量肝和脾的体积。通过咖啡因和红霉素评估肝代谢，通过胆酸盐、半乳糖和 SPECT 评估肝血流（HBF）和灌注肝质量（PHM）。根据 CT，基线到 T1 的再生率（kg(-1)体重日(-1)）为 0.60±0.22 mL，T1 到 T2 为 0.05±0.02 mL，T2 到 T3 为 0.01±0.01 mL；根据 SPECT，它们分别为 0.54±0.20、0.04±0.01 和 0.01±0.02。T3 时，根据 CT，肝体积为基线的 84%±7%，根据 SPECT，肝体积为基线的 92%±13%。肝代谢的变化没有达到统计学意义。T1 时，未调整的基线清除率分别为：静脉内胆酸盐为 0.75±0.07（P<0.001），半乳糖为 0.88±0.15（P=0.07），PHM 为 0.84±0.08（P=0.002），估计的 HBF 为 0.83±0.19（P=0.06）。T1 时，这些每升肝的比值比基线值高 50%以上，提示再生肝募集 HBF。胆酸分流增加、脾体积增加和血小板计数减少与门静脉循环改变一致。总之，初始肝再生迅速，占总再生的近三分之二，并与 HBF 和胆酸摄取增加有关。右半肝捐献改变了活体供者的门静脉循环，但如果存在任何长期临床后果尚不清楚。
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