Long-term prognosis after living donor liver transplantation with special reference to lipid and glucose metabolism and atherosclerosis

2000年4月至2003年3月，在东京大学医院和Dokkyo大学医院分别进行了132例和6例肝移植手术。我们报告了成人LT合并慢性GVHD的宝贵经验（文献#1）。我们首次使用右外侧扇区移植进行活体供体肝移植（LDLT），并报道了短期结果（参考文献#2）。我们提出了肝静脉重建和肝短静脉与左尾状叶小胆管胆肠吻合的手术方法，以保持其肝功能（文献# 3,4）。我们评估了左尾状叶小胆管胆肠吻合术后的远期效果，并证实了我们的方法（准备中）的有效性。我们建立了左肝移植物肝静脉重建的程序（参考文献#5），并在背台上进行了简单的测试，以证明单肝动脉重建（参考文献#6）。我们展示了LDLT中肝静脉中断导致的肝再生受损（文献#7），并建立了肝静脉重建的判定标准（文献#8）。我们详细介绍了右半肝移植在LDLT静脉重建中肝静脉重建的手术步骤（文献#9）。我们报道了使用小尺寸移植物的LDLT的短期结果（参考文献#10）。此外，我们还对移植肝功能进行了为期一年的随访，测定了被公认为可靠的肝功能指标的卵磷脂：胆固醇酰基转移酶（Lecithin: cholesterol acyltransferase， LCAT）的值。评估结果显示，小尺寸移植肝的肝功能逐渐恢复，在LDLT（准备中）后3个月达到正常水平。现就LDLT术后脂质代谢及动脉硬化问题进行探讨。首先，我们关注了载脂蛋白E （ApoE）的多态性，它对脂质代谢有很大影响，被认为是动脉粥样硬化的遗传风险。我们评估了ApoE多态性对正常受试者和胆固醇型胆结石患者胆脂组成的影响。因此，我们发现ApoE多态性对胆汁胆固醇分泌没有影响，也不是日本胆固醇胆结石的遗传风险（参考文献#11）。少

From April 2000 to March 2003, we performed liver transplantation (LT) in 132 and 6 cases in Tokyo University Hospital and Dokkyo University Hospital, respectively.1. We reported the precious experience of the case of adult LT associated with chronic GVHD (Reference #1).2. We first performed living-donor liver transplantation (LDLT) using right lateral sector graft, and reported the short-term results (Reference #2).3. We presented the surgical procedures of the hepatic venous reconstruction and the bilio-enteric anastomosis for the short hepatic veins and the small bile ducts in the left caudate lobe to preserve its hepatic function (Reference #3, 4). We assessed the long-term results after the bilio-enteric anastomosis for small bile ducts in the left caudate lobe, and confirmed the efficacy of our method (in preparation). We established the procedures the hepatic venous reconstruction of the left liver graft (Reference #5), and simple test on the back table for justifying single hep … More atic-arterial reconstruction (Reference #6).4. We showed the impaired liver regeneration with hepatic venous disruption in LDLT (Reference #7), and established the decision criteria for hepatic venous reconstruction (Reference #8). We presented in detail the operative procedures of hepatic venous reconstruction in venous reconstruction in LDLT using right hemiliver graft (Reference #9).5. We reported the short-term results of the LDLT using a small-for-size graft (Reference #10). In addition, we followed up the liver graft function for one year by the values of Lecithin: cholesterol acyltransferase (LCAT), which is accepted as a reliable indicator of liver function. The assessment showed that the liver function of the small-for-size graft recovered gradually and reached the normal level in 3 months after LDLT (in preparation).6. We now approach the problems of the lipid metabolism and the arterosclerosis after LDLT. At first, we paid attention to the polymorphism of apolipoprotein E (ApoE), which has much influence on lipid metabolism and is accepted as a genetic risk of atherosclerosis. We assessed the influence of ApoE polymorphism on bile lipid composition both in the normal subjects and the cholesterol gallstone patients. As a result, we showed that ApoE polymorphism has no influence on cholesterol secretion to the bile and is not a genetic risk for cholesterol gallstone in Japanese (Reference #11). Less