SEGAWA Hajime Kyoto University, Graduate School of Medicine, Associate Professor (60263076)
TAKADA Yasutsugu Kyoto University, Graduate School of Medicine, Associate Professor (10272197)
KAIHARA Satoshi Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Associate Professor (70324647)
EGAWA Yuto Kyoto University, Graduate School of Medicine, Associate Professor (40293865)
USHIGOME Hidetaka Kyoto Prefectural University of Medicine, 医学研究科, Assistant Professor (90405283)
吉村 了勇 京都府立医科大学, 医学研究科, 教授 (00191643)
|Budget Amount *help
¥3,710,000 (Direct Cost: ¥3,500,000、Indirect Cost: ¥210,000)
Fiscal Year 2007: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000)
Fiscal Year 2006: ¥2,800,000 (Direct Cost: ¥2,800,000)
Indocyanine green (ICG) can be used to measure cardiac output, index (CI), hepatic function, and blood volume. We used ICG to evaluate the effect of living donor liver transplantation (LDLT) for patients of end-stage liver diseases (ESLD) on perioperative hemodynamic changes and renal functions. Patient and Method: ICG examination was performed 20 adult LDLT in perioperative stage. Futhermore, examinations and were performed preoperative, immediate after LDLT (day 0), postoperative day (POD) 1, 2, 3, 7, 10, 14, 21 and 28. ICG elimination test was performed by spectrophotometric method and a noninvasive finger or nose-piece method. And renal function test including serum and urineβ2- microglobulin (BMG), fractional excretion of sodium (FENa), 24 hours creatinine clearance value(CCr), serum creatinine value(Cr), N-acetyl-β-D-glucosaminidase(NAG) value were measured at same time.
Result: CI was significantly higher until POD 10 than before LDLT (4.303ア1.294 vs 3.165±0.999 1/min/m^2: P<.05)
. After POD 14, CI was not significantly different between preLDLT and normalized(POD 14: 3.136±1.092, CI normal range 3-4 1/min/m^2). As regards renal function tests, when compare each factor by preoperative the 14th disease day, as CCr fall 75.9± 34.2 (ml/min) to 46.1±19.6. NAG shows 17.6±12.1(U/ to 14.0±11.6, it means the proximal tubule disorder. As for urine BMG shows
729.9±2012.5 (μg/I) to 939.21±431.3, it means that the renal tubule and glomerulus disorder. FENa shows 1.2±1.1 (%) to 1.0±0.7, it does not show a change. Cr shows 1.2±1.1 (mg/dl) to 0.7±0.3, as for Cr, it improved.
Conclusion: The characteristic of hemodynamics in ESLD patients is extremely large cardiac output, so-called hyperdynamic state. In this study, CI was significantly higher until POD 10 than before LDLT. Therefore, we think that hyperdynamic stage continue the minimum 10 days after LDLT. Although Cr value improved by LDLT, patent renal disorder existed, example for NAG and BMG value elevation. Although it was thought that the ICG test was extremely useful evaluation method for the circulation change of ESLD patient on perioperative period management, the improvement of the circulation change it doesn't necessarily mean improvement of the renal function. Therefore, we should have considered the factor except the circulation change when we thought about LDLT patient's renal function. Less