| Project/Area Number |
13470253
|
|---|
| Research Category |
Grant-in-Aid for Scientific Research (B)
|
| Allocation Type | Single-year Grants |
|---|
| Section | 一般 |
|---|
| Research Field |
Digestive surgery
|
|---|
| Research Institution | KYOTO UNIVERSITY |
|---|
Principal Investigator |
KIUCHI Tetsuya Department of Transplantation and Immunology, Kyoto University Graduate School of Medicine, Associate Professor, 医学研究科, 助教授 (40303820)
|
|---|
| Co-Investigator(Kenkyū-buntansha) |
KAIHARA Satoshi Department of Transplantation and Immunology, Kyoto University Graduate School of Medicine, Assistant Professor, 医学研究科, 助教授 (70324647)
EGAWA Hiroto Department of Transplantation and Immunology, Kyoto University Graduate School of Medicine, Associate Professor, 医学研究科, 助教授 (40293865)
TANAKA Koichi Department of Transplantation and Immunology, Kyoto University Graduate School of Medicine, Professor, 医学研究科, 教授 (20115877)
|
|---|
| Project Period (FY) |
2001 – 2002
|
| Project Status |
Completed (Fiscal Year 2002)
|
| Budget Amount *help |
¥13,600,000 (Direct Cost: ¥13,600,000)
Fiscal Year 2002: ¥4,400,000 (Direct Cost: ¥4,400,000)
Fiscal Year 2001: ¥9,200,000 (Direct Cost: ¥9,200,000)
|
|---|
| Keywords | Living donor liver transplantation / Small-for-size graft / Portal venous pressure / Liver regeneration / Graft congestion / Liver function / 腹水 / バクテリアルトランスロケーション / 脾動脈結紮 / 肝欝血 |
|---|
| Research Abstract |
Although living donor liver transplantation (LDLT) has been widely accepted as a treatment of choice for end-stage liver diseases, small-for-size grafts and their pathology leave many controversies in many programs. This study focused on pathogenesis of symptoms associated with small-for-size graft and aimed to establish the effective and safe treatment modality.
An antithrombotic catheter was inserted via the inferior mesenteric vein of recipient during operation, and portal vein pressure (PVP) was directly monitored for two weeks after surgery. In small-for-size grafts, compared with appropriate-size grafts, massive ascites, delay of graft regeneration, prolonged coagulopathy and cholestasis were observed commonly. Bacterial translocation possibly attributable either to reduce hepatic reticuloendothelial function or to alter mucosal immunity of intestine occurred in small-for-size grafts. These phenomena closely associated with elevated PVP, and PVP in small-for-size grafts during and
… More
after operation was significantly higher than that in appropriate-size grafts. Based on the results suggesting that elevated PVP serve a strong prognostic value, splenic artery ligation (SAL) was initiated at operation. SAL induced not only an immediate reduction of PVP, but also cumulative recipient survival in small-for-size grafts was improved.
In parallel, graft tissue congestion was investigated using magnetic resonance imaging. Morphologica1 changes compatible with congestion in the anterior segment occurred in 80-90% of right grafts without additional drainage reconstruction. However, congestion improved gradually in most grafts after several months. Graft congestion was associated with neither deteriorated liver function nor elevated PVP. However a tentative but significant positive correlation was observed between amount of ascites in the third or fourth week after surgery and total graft congestion in first month.
In conclusion, elevated PVP in the early phase is strongly associated with poor prognosis attributable to small-for-size graft. However SAL induces an immediate and persistent reduction of PVP and gives positive effects on graft and patient prognosis. Less
|
