| Project/Area Number |
13671231
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
General surgery
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| Research Institution | KYOTO UNIVERSITY |
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Principal Investigator |
OIKE Fumitaka Kyoto University Transplant Surgery Assistant, 医学研究科, 助手 (20324650)
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| Co-Investigator(Kenkyū-buntansha) |
KIUCHI Tetsuya Nagoya University Transplant Surgery Professor, 医学研究科, 教授 (40303820)
UEMOTO Shinji Mie University Surgery Professor, 医学部, 教授 (40252449)
TANAKA Koichi Kyoto University Transplant Surgery Professor, 医学研究科, 教授 (20115877)
KAIHARA Satoshi Kyoto University Transplant Surgery Assistant Professor, 医学研究科, 講師 (70324647)
EGAWA Hiroto Kyoto University Transplant Surgery Assistant Professor, 医学研究科, 助教授 (40293865)
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| Project Period (FY) |
2001 – 2002
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| Project Status |
Completed (Fiscal Year 2002)
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| Budget Amount *help |
¥3,600,000 (Direct Cost: ¥3,600,000)
Fiscal Year 2002: ¥300,000 (Direct Cost: ¥300,000)
Fiscal Year 2001: ¥3,300,000 (Direct Cost: ¥3,300,000)
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| Keywords | living donor liver transplantation / Infection / graft saize / portalvenous pressure / bacterial translocation / cellular factors |
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| Research Abstract |
It has been shown that survival in smallforsize grafts is worse in living donor liver transplantation (LDLT). The 1-year survival rate in non-ICU bound patients was 91.8% with graft-to-recipient weight ratio (GRWR) of 【greater than or equal】1.0%, 79.5% with GRWR of 0.8-1.0%, and 59.7% with GRWR of < 0.8%. The difference by graft size was even greater in ICU-bound patients
In many failed cases, the direct cause of death was infection. To examine the relationship between graft size and infection, a portal catheter was placed in 79 LDLT cases
Portal vein pressure (PVP) was significantly high in small-for-size grafts. The patients with elevated PVP (【greater than or equal】20 mmHg) demonstrated significantly worse survival (84.5 %vs.38.5%) . In these cases, the incidence of bacteremia was high (64.0% ;PVP 【greater than or equal】20mmHg, 28.8% ;PVP <20mmHg), indicating the association of infection with poor survival
Enteral feeding was introduced in adult LDLT in order to reduce the posttransplant infection by preventing the mucosal injury and by maintaining the normal bacterial flora, because the high incidence of infectious complication in small-for-size grafts is presumably associated with the same mechanisms that promote bacterial translocation observed in rat model of hepatic resection. Enteral feeding also eliminated the long use of central venous catheterization, resulting in the decrease in the risk for catheter-related sepsis
Based on the preliminary result that high PVP may display a strong prognostic value, splenic artery was ligated in seven cases with either elevated PVP (【greater than or equal】20 mmHg after arterial reperfusion) or small-for-size grafts (GRWR< 1.0%). Despite significantly smaller GRWR in patients with splenic artery ligation (SAL), posttransplant PVP was significantly lower than that in non-SAL patients and also survival was significantly better than that in non-SAL patients with high early PVP
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