Ku Y, Fukumoto T, Nishida T, Tominaga M, Maeda I, Kitagawa T, Takao S, Shiotani M, Tseng A, Kuroda Y
First Department of Surgery, Kobe University School of Medicine, Japan.
Transplantation. 1995 May 27;59(10):1388-92. doi: 10.1097/00007890-199505270-00005.
The minimum graft volume still remains unclear in reduced-size liver transplantation (RLT). This study reports the improved survival of canine RLT using a quarter graft with the aid of a portahepatic vein shunt (PHVS). In beagles, the donor liver was reduced to the right lateral and caudate lobes (quarter graft) with or without provision of PHVS, and transplanted orthotopically in the recipient. The PHVS was established by an end-to-end anastomosis of the portal vein branch and the hepatic vein in the resected left lateral lobe. Liver chemistries including arterial blood ketone body ratio (AKBR) were serially measured during and after surgery. All seven animals with PHVS survived more than 3 days (mean +/- SD; 5.3 +/- 1.7 days), whereas all six without PHVS died within 3 days (1.8 +/- 0.8 days, P < 0.01). Portal vein pressures immediately after recirculation in animals with and without PHVS were 8.5 +/- 1.2 mmHg and 16.9 +/- 3.1 mmHg, respectively (P < 0.01). Regardless of the presence or absence of PHVS, AKBR dropped to a level lower than 0.7 during the anhepatic period and returned promptly to above 1.0 as early as 30 min after recirculation. Thereafter, the AKBR values in animals with PHVS remained higher than 1.0, whereas those in animals without PHVS showed a progressive decrease, showing a statistically significant difference between the two groups after 12 hr (P < 0.05). Graft function, as assessed by AKBR, was well correlated with survival and other liver chemistries. These results indicate that, in an extreme RLT, portal hypertension is a risk factor predisposing to graft failure, most likely by increasing microvascular injury after recirculation.
在减体积肝移植（RLT）中，最小移植肝体积仍不明确。本研究报告了借助肝门静脉分流术（PHVS）使用四分之一肝脏移植的犬类RLT的生存率提高情况。在比格犬中，将供体肝脏缩小至右侧叶和尾状叶（四分之一肝脏移植），并设置或不设置PHVS，然后原位移植到受体中。通过将切除的左侧叶门静脉分支与肝静脉进行端端吻合来建立PHVS。在手术期间和术后连续测量包括动脉血酮体比（AKBR）在内的肝脏生化指标。所有七只接受PHVS的动物存活超过3天（平均值±标准差；5.3±1.7天），而所有六只未接受PHVS的动物在3天内死亡（1.8±0.8天，P<0.01）。接受和未接受PHVS的动物再灌注后立即测得的门静脉压力分别为8.5±1.2 mmHg和16.9±3.1 mmHg（P<0.01）。无论是否存在PHVS，在无肝期AKBR均降至低于0.7的水平，并在再灌注后30分钟内迅速恢复至高于1.0。此后，接受PHVS的动物的AKBR值保持高于1.0，而未接受PHVS的动物的AKBR值则逐渐下降，两组在12小时后显示出统计学上的显著差异（P<0.05）。通过AKBR评估的移植肝功能与生存率和其他肝脏生化指标密切相关。这些结果表明，在极端的RLT中，门静脉高压是导致移植失败的危险因素，很可能是通过增加再灌注后的微血管损伤来实现的。
