1994 Fiscal Year Annual Research Report

生体肝移植における移植肝容積量と自己肝温存同所性生体部分肝移植の開発に関する研究

Research Project

Project/Area Number	06404046
Research Institution	Kyoto University
Principal Investigator	田中紘一京都大学, 医学部, 助教授 (20115877)
Co-Investigator(Kenkyū-buntansha)	猪俣裕紀洋京都大学, 医学部, 講師 (50193628) 田中明京都大学, 医学部, 講師 (00240820) 本田和男京都大学, 医学部, 講師 (00209321) 山岡義生京都大学, 医学部, 教授 (90089102)
Keywords	肝移植 / 肝再生 / 門脈血流量 / 生体肝移植分肝機能 / 自己肝温存同所性部分肝移植
Research Abstract	生体部分肝移植は、幼少時に対する末期肝疾患の治療法として確立されつつあり、われわれはこれまで150例と世界でもっとも多くの症例に本法を実施してきた。本研究の目的は本法を成人末期肝疾患に適応するために、成人への必要移植肝容積量の決定自己肝温存同所性部分肝移植法の開発である。 1)ビ-グル犬を用いて、全肝摘出後にそれぞれ容積量の異なる部分肝を移植しドナー肝とレシピエント肝との容積比を比較して移植犬の生存にどれほどの移植肝容積が必要か求めた。その結果ドナーの全肝に対し25%の移植肝容量が生着にとって限界であることを明らかにした。 2)実際の臨床生体肝移植では、レシピエントの適応年令を年長へと次第に拡大し、移植肝の重量とレシピエントの体重比から必要容量を求めた。これまで16才〜18才のレシピエント4例生体肝移植を施行した。レシピエントの最大体重は60kgであった。この結果、移植肝重量とレシピエントの体重比は0.6%で、標準肝重量の30%の移植肝容量があれば、肝移植後の生存が可能であることが示唆された。このことを踏まえ、49才47.2kg原発性胆汁性肝硬変の末期状態に対し、妹の肝左葉280gを移植し究明に成功した。今後、限られた状況下で成人生体肝移植が可能であることが解った。 3)自己肝温存同所性部分肝移植の開発:ビ-グル犬を用い、レシピエント犬の肝右外側二葉を温存し、かつ胆管結紮して閉塞性黄疸をきたす障害肝を作成、この犬に左外側二葉(全肝の約35%)を移植した。このモデル作成の成功後、門脈血流分配、個別の肝機能、グラフトの再生について検討した。この結果、本法の手技上の安定性が確立できたので、今後本法を代謝性肝疾患、劇症肝不全、移植肝容量が不足である肝疾患末期状態の治療に応用する道が開けた。

Research Products

(18 results)

All Other

All Publications (18 results)

[Publications] K.Tanaka,: "Living-related liver transplantation for fulminant hepatic failure in children" Transpl Int.7(s). S108-110 (1994)
[Publications] A.Tokuka,: "Interrelationship of oxygen supply by the hepatic artery and portal vein;Rapid analysis of ischemia-reflow induced changes in hepatic oxygenation by tissue near infrared spectroscopy." European Surgical Research. (in press).
[Publications] T Morimoto: "Donor safety in living related liver transplantation." JAMA. (in press).
[Publications] Yoshio Yamaoka,: "Safety of the donor in riving-related liver transplantation-An analysis of 100 parental donors1,2" transplantation. 59. 1-3 (1995)
[Publications] H,Someda,: "Vasculation complication in living related donor transplantation detected with intraoperative and postoperative Doppler US" Hepatology,. (in press).
[Publications] Habib N: "Living-related liver transplantation in adult recipients:A hypothesis" Clin.Transplantation. 9. 31-34 (1995)
[Publications] T.Morimoto,: "Analysis of functional abnormalities uncovered during preoperative evaluation of donor canditates for living-related liver transplantation." Clinical Transplantation. 9. 60-64 (1995)
[Publications] M.Ichimiya,: "Insulin and glucagon levels in living related liver transplantation:Their interaction with the recovery of graft liver function" Transplant International. 8. (1995)
[Publications] M.Yasuhara,: "Pharmacokinetics and pharmacodynamics of FK506 in pediatric patients receiving living-related donor liver transplantations" Transplantation Proceedings. 27. 1108-1110 (1995)
[Publications] N.Yanabu,: "Evaluation of circulation status with tissue near-infrared spectroscopy in living related liver transplantation across ABO blood groups" Transplantation Proceedings. 27. 1160-1163 (1995)
[Publications] T.Morimoto,: "Donor safety in living related liver transplantation" Transplantation Proceedings. 27. 1168-1169 (1995)
[Publications] M.Fujimoto,: "Evaluation of portal hemodynamics with Doppler ultrasound in living related donor liver transplantation in children:Implications for ligation of spontaneous portosystemic collateral pathways" Transplantation Proceedings. 27. 1174-1176 (1995)
[Publications] H.Terajima,: "Timing of transplantation and donor selection in living related liver transplantation for fulminant Wilson's disease" Transplantation Proceedings. 27. 1177-1178 (1995)
[Publications] A.Tanaka,: "Living related liver transplantation for across ABO blood groups Evaluation of hemodynamics with tissue near-infrared spectroscopy." Transplantation. 58. 548-553 (1994)
[Publications] S.Uemoto,: "Long-tern use of FK506 in living related liver transplantation" Transplantation International. 7(S). S81-84 (1994)
[Publications] A.Tokuda,: "Dalayed oxidation of intramitochondrial nucleotide oxido reducation state as compared with tissue oxygenation in human liver transplantation" Transplantation International. 7(S). S496-S498 (1994)
[Publications] Y.Yamaoka,: "Liver transplantation using a right lobe graft from a living related donor." Transplantation. 57. 1127-1130 (1994)
[Publications] S.Iwata,: "Biochemical and biophysical alteration of lipoprotein after liver transplantation from living related donor:A biochemical and proton NMR study." Research in Experimental Medicine. 194. 313-320 (1994)

1994 Fiscal Year Annual Research Report

生体肝移植における移植肝容積量と自己肝温存同所性生体部分肝移植の開発に関する研究

Principal Investigator

田中 紘一 京都大学, 医学部, 助教授 (20115877)

Research Products

[Publications] K.Tanaka,: "Living-related liver transplantation for fulminant hepatic failure in children" Transpl Int.7(s). S108-110 (1994)

[Publications] A.Tokuka,: "Interrelationship of oxygen supply by the hepatic artery and portal vein;Rapid analysis of ischemia-reflow induced changes in hepatic oxygenation by tissue near infrared spectroscopy." European Surgical Research. (in press).

[Publications] T Morimoto: "Donor safety in living related liver transplantation." JAMA. (in press).

[Publications] Yoshio Yamaoka,: "Safety of the donor in riving-related liver transplantation-An analysis of 100 parental donors1,2" transplantation. 59. 1-3 (1995)

[Publications] H,Someda,: "Vasculation complication in living related donor transplantation detected with intraoperative and postoperative Doppler US" Hepatology,. (in press).

[Publications] Habib N: "Living-related liver transplantation in adult recipients:A hypothesis" Clin.Transplantation. 9. 31-34 (1995)

[Publications] T.Morimoto,: "Analysis of functional abnormalities uncovered during preoperative evaluation of donor canditates for living-related liver transplantation." Clinical Transplantation. 9. 60-64 (1995)

[Publications] M.Ichimiya,: "Insulin and glucagon levels in living related liver transplantation:Their interaction with the recovery of graft liver function" Transplant International. 8. (1995)

[Publications] M.Yasuhara,: "Pharmacokinetics and pharmacodynamics of FK506 in pediatric patients receiving living-related donor liver transplantations" Transplantation Proceedings. 27. 1108-1110 (1995)

[Publications] N.Yanabu,: "Evaluation of circulation status with tissue near-infrared spectroscopy in living related liver transplantation across ABO blood groups" Transplantation Proceedings. 27. 1160-1163 (1995)

[Publications] T.Morimoto,: "Donor safety in living related liver transplantation" Transplantation Proceedings. 27. 1168-1169 (1995)

[Publications] M.Fujimoto,: "Evaluation of portal hemodynamics with Doppler ultrasound in living related donor liver transplantation in children:Implications for ligation of spontaneous portosystemic collateral pathways" Transplantation Proceedings. 27. 1174-1176 (1995)

[Publications] H.Terajima,: "Timing of transplantation and donor selection in living related liver transplantation for fulminant Wilson's disease" Transplantation Proceedings. 27. 1177-1178 (1995)

[Publications] A.Tanaka,: "Living related liver transplantation for across ABO blood groups Evaluation of hemodynamics with tissue near-infrared spectroscopy." Transplantation. 58. 548-553 (1994)

[Publications] S.Uemoto,: "Long-tern use of FK506 in living related liver transplantation" Transplantation International. 7(S). S81-84 (1994)

[Publications] A.Tokuda,: "Dalayed oxidation of intramitochondrial nucleotide oxido reducation state as compared with tissue oxygenation in human liver transplantation" Transplantation International. 7(S). S496-S498 (1994)

[Publications] Y.Yamaoka,: "Liver transplantation using a right lobe graft from a living related donor." Transplantation. 57. 1127-1130 (1994)

[Publications] S.Iwata,: "Biochemical and biophysical alteration of lipoprotein after liver transplantation from living related donor:A biochemical and proton NMR study." Research in Experimental Medicine. 194. 313-320 (1994)

田中紘一京都大学, 医学部, 助教授 (20115877)