| Project/Area Number |
17390349
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| Research Category |
Grant-in-Aid for Scientific Research (B)
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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 (2006)
Mie University (2005) |
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Principal Investigator |
UEMOTO Shinji Kyoto University, Graduate School of Medicine, Department of Surgery, Department of Surgery Professar (40252449)
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| Co-Investigator(Kenkyū-buntansha) |
SHIRAISHI Taizo Mie University, Graduate School of Medicine, Department of Pathology, Department of Pathology Professor (30162762)
NAGAHAMA Masato Suzuka Medical Science University, 医用工学部臨床工学科, Professor (50198355)
TABATA Masami Mie University, Graduate School of Medicine, Department of Surgery, Department of Surgery Lecturer (90291418)
横井 一 三重大学, 大学院・医学系研究科, 講師 (60174843)
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| Project Period (FY) |
2005 – 2006
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| Project Status |
Completed (Fiscal Year 2006)
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| Budget Amount *help |
¥7,300,000 (Direct Cost: ¥7,300,000)
Fiscal Year 2006: ¥3,200,000 (Direct Cost: ¥3,200,000)
Fiscal Year 2005: ¥4,100,000 (Direct Cost: ¥4,100,000)
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| Keywords | living donor liver transplantation / small-for-size graft / liver regeneration / portal venous pressure / portal venous flow / donor operation / 門脈血行動態 / 肝再生因子 / 門脈血流量 / グラフト肝機能 / 門脈周辺臓器 |
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| Research Abstract |
Excellent liver regeneration after hepatectomy or partial liver transplantation in porcine model was achieved in the group with portosystemic shunt comparing with the group without shunt. The above finding led to the concept that adequate portal venous pressure and flow is essential to obtain good liver regeneration. At the same time, retrospective clinical study for living donor liver transplantation (LDLT) demonstrated that portal venous pressure less than 20mmHg was crucial factor to obtain better clinical outcome with good liver regeneration. At the next step, we performed prospective clinical study of LDLT at Mie University Hospital, in which portal venous pressure was maintained under 20mmHg and sufficient portal venous flow was secured by Doppler ultrasound examination, by means of splenectomy, portosystemic shunt between inferior mesenteric vein and left renal vein, or interception of spontaneous collaterals. As a result, recipient survival was dramatically improved up to 90%. That strategy with modification of portal venous circulation in LDLT had been applied to LDLT at Kyoto University Hospital since 2006, and better outcome (over 90% of recipient survival) has been obtained. In addition, further modification making portal venous pressure less than 17mmHg resulted in better outcome even in recipients receiving small-for-size grafts, defined by low GRWR (graft-recipient weight ratio) ranging from 0.8 to 0.6. As a result, the lowest limit of GRWR in LDLT can be shifted from 0.8 to 0.7, and we can use left lobes rather than right lobes. Changes in graft selection from right lobe to left lobe would contribute to safety of donor operation.
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