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

从2000年4月至2003年3月，我们分别在东京大学医院和独协大学医院实施了132例和6例肝移植（LT）。我们报告了成人LT伴慢性GVHD病例的宝贵经验（参考文献1）。我们首先使用右侧肝移植进行活体肝移植（LDLT），并报告了短期结果（参考文献2）。我们介绍了肝静脉重建和胆肠吻合术，用于肝短静脉和左尾状叶小胆管，以保留其肝功能（参考文献#3，4）。我们评估了左尾状叶小胆管胆肠吻合术后的长期结果，并证实了我们方法的有效性（准备中）。我们建立了左肝移植肝静脉重建的程序（参考文献5），并在后台上进行了简单的试验，以证明单肝移植的合理性。 关于我们 动脉重建（参考文献#6）。我们显示了LDLT中肝静脉破坏的肝再生受损（参考文献7），并建立了肝静脉重建的决策标准（参考文献8）。我们详细介绍了在使用右半肝移植物的肝静脉重建中进行肝静脉重建的手术程序（参考文献9）。我们报告了使用小尺寸移植物进行LDLT的短期结果（参考文献10）。此外，我们通过胆固醇酰基转移酶（LCAT）的值对移植肝功能进行了一年的随访，LCAT被认为是肝功能的可靠指标。评估结果显示小体积移植物肝功能逐渐恢复，在LDLT（准备中）后3个月达到正常水平.我们现在探讨LDLT后脂质代谢和动脉硬化的问题。载脂蛋白E（ApoE）基因多态性对脂代谢有重要影响，被认为是动脉粥样硬化的遗传危险因素。我们评估了ApoE基因多态性对正常人和胆固醇结石患者胆汁脂质组成的影响。结果，我们表明ApoE多态性对胆固醇分泌到胆汁中没有影响，并且在日本人中不是胆固醇结石的遗传风险（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