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

1995 Fiscal Year Annual Research Report

• Project/Area Number: 06404046
• Research Institution: KYOTO UNIVERSITY
• Principal Investigator: 田中 鉱一 京都大学, 医学研究科, 教授 (20115877)
• Co-Investigator(Kenkyū-buntansha): 猪股 裕紀洋 京都大学, 医学研究科, 助教授 (50193628) ; 本田 和男 京都大学, 医学研究科, 講師 (00209321) ; 山岡 義生 京都大学, 医学研究科, 教授 (90089102)
• Keywords: 肝再生 / 移植肝サイズマッチング / 肝移植 / 自己肝温存同所性部分肝移植 / 肝組織酸素化

Research Abstract

生体部分肝移植において、近赤外光分析、血中ケトン体比、肝逸脱酵素によりグラフト肝の代謝能力について解析を行い、グラフトサイズマッチングについて検討した。
1) グラフト重量/レシピエント体重比(GW/BW比)と移植肝生着との関連:分析した100例のレシピエント体重は平均14.1kg(4.0〜58.0kg)、グラフト重量は260.4g(174〜440g)GW/BW比は2.61%(0.61〜6.0%)であった。生着率からみてGW/BW比は特に偏りはなかった。成人生体肝移植の可能性が示唆された。
2) 肝組織酸素化とGW/BW比の関連:組織酸素化は門脈血流再開後にはGW/BW比と相関を示し、相対的に大きなグラフトは均一には酸素化されないが動脈血再開後にはこの不均一性は消失した。肝機能の面からは大きなグラフト移植時は相対的血流不足による肝虚血の影響が示唆された。
3) グラフト代謝能とGW/BW比の関連:術後のビリルビン低下パターンから相対的にグラフトが小さいと代謝能に問題があるが、移植肝の早期再生により、代謝能力に及ぼすグラフトサイズマッチングの影響は消失した。
4) GW/BW比0.50%であったレシピエント(19才、55kg)に自己肝温存同所性生体部分肝移植を施工した。移植肝への血流は十分保持され、術後3週間で移植肝は再生し、病的肝は萎縮の傾向を示した。成人生体肝移植ならびに劇症肝不全、代謝性肝臓疾患に適応しうる術式であることが解明できた。

Research Products

• [Publications] T. Kitai.: "Intraoperative measurement of the graft oxygenation state in living related liver transplantation by near infrared spectroscopy" Transplantation International. 8. 111-118 (1995)
• [Publications] Y. Yamaoka: "Safety of the donor in riving-related liver transplantation-An analysis of 100 parental donors" Transplantation. 59. 224-226 (1995)
• [Publications] Habib N: "Living-related liver transplantation in adult recipients : A hypothesis" Clin. Transplantation. 9. 31-34 (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 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] M. Fujimoto: "Recovery of graft circulation following percutaneous transluminal angioplasty for stenotic venous complications in pediatric liver transplantation : assessment with Doppler ultrasound" Transplant International. 8. 119-125 (1995)
• [Publications] T. Inomoto: "The use of recipient sigmoid artery for a revision of hepatic arterial reconstruction after thrombosis in living related liver transplantation" Transplantation. 60. 881-882 (1995)
• [Publications] M. Ueda: "A proposal of FK506 optimal dosing in living-related liver transplantations" Transplantation. 60. 258-264 (1995)
• [Publications] T. Inomata: "Evolution of immunosuppression with FK506 in pediatric living related liver transplantation" Transplantation. 61. 247-252 (1996)
• [Publications] Y. Shirakata: "Inhibitory effect of plasma FKBP12 on immunosuppressive activity of FK506" Transplantation. (in press).
• [Publications] T. Morimoto: "Analysis of functional abnormalities uncovered during preoperative evaluation of donor canditates for living-relate liver transplantation." Clinical Transplantation. 9. 60-64 (1995)
• [Publications] T. Morimoto: "Donor safety in living related liver transplantation." JAMA. 27. 1166-1169 (1995)
• [Publications] H. Someda: "Vascular complications in living related donor transplanation detected with intraoperative and postoperative Doppler US" Hepatology. 22. 623-632 (1995)
• [Publications] M. Ichinomiya: "Insulin and glucagon levels in living related liver transplantation : Their interaction with the recovery of graft liver function" Transplant International. 8. 165-168 (1995)
• [Publications] R. Denno: "The ratio of reduced glutathione/oxidized glutathione is maintatined in the liver during short-term hepatic hypoxia" Journal of Gastroenteerology. 30. 1338-1346 (1995)
• [Publications] S. Fukushima: "The frequency of 4977 base pair deletion of Mitochondrial DNA in various types of liver disease and in normal liver" Hepatology. 21. 1547-1551 (1995)
• [Publications] Y. Yamaoka: "Liver transplantation using a right lobe graft from a living related donor." Transplantation. 57. 1127-1130 (1994)
• [Publications] A. Tanaka: "Living related liver transplantation across ABO blood groups evalutation of hemodynamics with tissue near-infrared spectroscopy." Transplantation. 58. 548-553 (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)
• [Publications] T Morimoto: "Questionnaire to donors participating in living related liver transplantation with regard to postiperative quality of life." J Transplant Coodination. 4. 126-131 (1994)