Auxiliary heterotopic partial liver transplantation in pigs with acute liver failure
Auxiliary heterotopic partial liver transplantation in pigs with acute liver failure
复制标题
急性肝功能衰竭猪的辅助异位部分肝移植
DOI：
10.1007/bf00311820
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发表时间：
1995
期刊：
影响因子：
--
通讯作者：
K. Dohi
中科院分区：
文献类型：
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作者：
S. Marubayashi;T. Asahara;E. Ono;H. Tashiro;K. Okugawa;T. Okimoto;O. Sanada;H. Nakahara;T. Maeda;K. Nitta;Y. Oshiro;H. Sakimoto;Naoshi Shigeta;M. Nishihara;M. Furukawa;Hiroshi Watanabe;H. Yahata;Y. Fukuda;K. Dohi
暴发性肝功能衰竭通常是致命的，没有肝移植;然而，原位肝移植往往是难以执行，由于凝血功能障碍的高风险和多器官功能衰竭的发展。辅助性异位部分肝移植（APLT），然而，有可能提供一个有效的肝脏支持系统，考虑到宿主肝脏留在原位，外科手术创伤较小。在这份报告中，我们描述了进行60% APLT对肝动脉结扎诱导的急性肝功能衰竭猪的肝功能和存活率的有益影响。将猪分为对照组（9只动物）（第1组）和APLT组（7只动物）（第2组），对照组采用侧-侧门腔分流术结扎门静脉和肝动脉，APLT组采用APLT结扎门静脉和肝动脉。切除供体肝脏的两个左侧叶，将肝脏重量减少到约60%，并将移植物放置在右肝下间隙。术中未发生死亡。在第1组中，8头猪在48 h内死于大面积肝坏死，1头在48 - 72 h之间死亡（中位存活期23 h）。第2组有2头猪在72 h内因保存或麻醉问题死亡，但有5头存活3 d以上（中位存活13.4 d），两组间差异显著（P<0.05）。一只动物在APLT后30天被处死，凝血因子的合成、氨解毒和葡萄糖稳态证明了良好的移植功能。此外，在移植的肝脏中发现了肝再生的证据。这些结果表明，APLT提供了代谢支持，并提高了诱导急性肝衰竭动物的生存率。
Fulminant hepatic failure is usually fatal without liver transplantation; however, orthotopic liver transplantation is often difficult to perform due to the high risk of coagulopathy and the development of multiple organ failure. Auxiliary heterotopic partial liver transplantation (APLT), however, has the potential to provide an effective hepatic support system considering that the host liver is left in situ and the surgical procedure is less invasive. In this report, we describe the beneficial effects of performing 60% APLT on the hepatic function and survival of pigs with acute hepatic failure induced by hepatic artery ligation. The pigs were divided into a control group of nine animals (group 1) that had portal vein and hepatic artery ligation with a side-to-side portacaval shunt, and an APLT group of seven animals (group 2) that had portal vein and hepatic artery ligation with APLT. The two left lateral lobes of the donor liver were resected, reducing the liver weight to about 60%, and the graft was placed in the right subhepatic space. No deaths occurred intraoperatively. In group 1, eight pigs died of massive liver necrosis within 48 h and one died between 48 and 72 h (median surivival 23 h). In group 2, two pigs died within 72 h due to preservation or anesthetic problems, but five survived for more than 3 days (median survival 13.4 days), with a significant difference between the two groups (P<0.05). One animal was killed 30 days after APLT and excellent graft function was demonstrated by the synthesis of clotting factors, ammonia detoxification, and glucohomeostasis. Moreover, evidence of hepatic regeneration was found in the transplanted livers. These results indicate that APLT provides metabolic support and improves survival in animals with induced acute liver failure.