ID 98219
Title Transcription
セイタイ カンイショク ニオケル カショウ グラフト ノ ビョウタイ セイリ ト チリョウ センリャク
Title Alternative
Treatment strategy for small-for-size graft in living donor liver transplantation
Author
Shimada, Mitsuo Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School Tokushima University Educator and Researcher Directory KAKEN Search Researchers
Soejima, Yuji Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School
Fujii, Masahiko Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School
Morine, Yuji Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School Tokushima University Educator and Researcher Directory KAKEN Search Researchers
Imura, Satoru Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School Tokushima University Educator and Researcher Directory KAKEN Search Researchers
Ikemoto, Tetsuya Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School Tokushima University Educator and Researcher Directory KAKEN Search Researchers
Keywords
small-for-size graft
shear stress
splenectomy
splenic artery ligation
hyperbaric oxygen therapy
heat shock protein
Content Type
Journal Article
Description
Introduction : To save the small-for-size graft in living donor adult liver transplantation (LDALT), it is necessary to overcome the following problems:1)excessive portal inflow;2)
graft congestion;3)small functional liver mass ; and4)inadequate intragraft responses.
Treatments for the small-for-size graft.
1)To avoid excessive portal inflow(: a)Splenctomy or splenic artery ligation to reduce portal pressure and flow ; and b)Portocaval shunt to reduce portal pressure and flow.
2)To avoid graft congestion : a)Graft venoplasty and graft hepatic vein to the IVC anastomosis in left lobe grafts, and reconstruction of significant venous tributaries from the middle hepatic vein in right lobe grafts ; and(b)Intraportal administration of drugs(PG-E1, etc.)to prevent microcirculatory disturbance.
3)To avoid liver failure due to small functional liver mass : Hyperbaric oxygen therapy is a feasible option for a persistent functional hyperbiliruminemia.
4)To modulate inadequate intragraft responses(: a)Induction of heat shock protein into the graft to suppress up-regulation of inflammatory cytokines, and to improved survival rate after 95%-hepatectomy(Hx)in rats ; and(b)Slow-down of liver regeneration to reduce liver injury and to improve survival rate after90%-Hx in rats.
Conclusions : Pathophysiology-oriented strategy against small-for-size graft is effective in LDALT.
Journal Title
四国医学雑誌
ISSN
00373699
NCID
AN00102041
Publisher
徳島医学会
Volume
62
Issue
1-2
Start Page
30
End Page
37
Sort Key
30
Published Date
2006-04-25
Remark
FullText File
language
jpn
departments
Medical Sciences
University Hospital