Experimental partial liver transplantation using gradual occlusion of the portal vein for pediatric patient

用从心脏跳动的尸体上获得的全肝原位替代病变肝脏是肝移植的标准技术。然而，缺乏大小匹配的供体肝脏导致了儿童肝移植的困难。部分杠杆移植是解决这个问题的一种方法。一种新的原位部分肝移植技术，在杂种狗身上部分保留了宿主的杠杆。我们采用了两种不同的方法将门静脉从受者的肝脏转移到移植物的肝脏。渐进式闭塞组：在切除受体左、中肺叶后，将供肝左肺叶在空间内原位移植。在受体右侧门静脉上放置Ameroid缩窄器，逐渐阻断受体门静脉流入。结扎右肝管和右肝动脉。本组33只犬中有18只存活时间超过2…4小时，平均存活时间为7.7 5.8天（n=18）。一只狗在移植后存活了19天。存活时间最长的狗移植物外观基本正常，门静脉周围有少量单核细胞浸润。解剖时移植的重量增加了一倍。另一方面，受体的残肝显示肝细胞萎缩和坏死。结扎组：结扎受体右侧门静脉，不逐渐闭塞。11只狗中，有8只存活超过24小时，平均存活时间为4.5 - 3.6天（n=8）。逐渐闭塞组的生存率明显优于结扎组。两组均采用环孢素a （5 mg/kg/day）和甲基强的松龙（1 ~ 10 mg/kg/day）进行免疫抑制。由于该技术不需要完全闭塞腔静脉或门静脉，因此不需要外部静脉-静脉分流术，而且避免了全肝切除术，移植物失败并不意味着受体的恶化。该方法具有部分原位肝移植和异位肝移植的优点。少

Orthotopic replacement of the diseased liver by a whole liver obtained from a heart beating cadaver is the standard technique for liver transplantation. However, the shortage of a size-matched donor liver has contributed to the difficulty in pediatric liver transplantation. A partial lever transplntation is one solution of this problem. A new technique of orthotopic partial liver transplantation, which partially retains the host lever, has been developed in the mongrel dog.We pefrormed two different methods for diversion of the portal venous inflow from the recipient's liver to the graft's one.Gradual occlusion group: The left lobe of the donor liver was transplanted orthotopically in the space after removal of the left and central lobes of the recipient. An Ameroid constricotor was placed on the recipient's right portal vein to occlude the recipient's portal inflow gradually. Right hepatic duct and right hepatic artery were ligated. 18 of 33 dogs in this group survived for more than 2 … More 4 hours and the mean survival time was 7.7 5.8 days(n=18). One dog survived for 19 days after transplantation. Graft of the longest survived dog showed almost normal appearance and slight mononuclear cell infiltration in the periportal area. The weight of the graft doubled at autopsy. On the other hand, the recipient's remnant liver revealed atrophy and necrosis of the hepatocyte.Ligation group: The recipient's right portal vein was ligated instead of the gradual occlusion. Of 11 dogs, 8 dogs survived for more than 24 hours and mean survival time was 4.5 3.6 days(n=8). It seemed that the survival rate of the gradual occlusion group was better than that of ligation group.Cycloporin-A(5 mg/kg/day) and methylprednisolone(1-10 mg/kg/day) were used as immunosup-pression in the both groups.Since this technique does not tequire complete occlusion of either caval vein or the portal vein, external veno-venous shunt is unnecessary, Furthermore the total hepatectomy is avoided and graft failure does not mean the recipient's deterioration. This method has the advantages of both patial orthotopic and heterotopoic liver transplantation. Less