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
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Title Alternative | Treatment strategy for small-for-size graft in living donor liver transplantation
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Author |
Shimada, Mitsuo
Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School
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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
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Imura, Satoru
Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School
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Ikemoto, Tetsuya
Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School
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Keywords | small-for-size graft
shear stress
splenectomy
splenic artery ligation
hyperbaric oxygen therapy
heat shock protein
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Content Type |
Journal Article
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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
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ISSN | 00373699
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NCID | AN00102041
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Publisher | 徳島医学会
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Volume | 62
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Issue | 1-2
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Start Page | 30
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End Page | 37
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Sort Key | 30
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Published Date | 2006-04-25
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Remark | |
FullText File | |
language |
jpn
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departments |
Medical Sciences
University Hospital
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