Clinical research on the pathogenesis and treatment of portal hemodynamics and pathological regeneration in small-for-size liver grafts after living donor liver transplantation: Pathogenesis and clinical innovation

尽管活体肝移植（LDLT）已被广泛接受为终末期肝病的治疗选择，但小体积移植物及其病理学在许多方案中留下了许多争议。本研究旨在探讨小体积移植物相关症状的发病机制，并建立有效、安全的治疗模式，术中经受体肠系膜下静脉插入抗血栓导管，术后2周直接监测门静脉压力（PVP）。与合适大小的移植物相比，小体积移植物常见大量腹水、移植物再生延迟、凝血功能障碍和胆汁淤积。细菌移位可能是由于降低肝脏网状内皮功能或改变肠道粘膜免疫发生在小尺寸移植。这些现象与PVP升高密切相关，并且在小尺寸移植物中， 关于我们 术后移植物的平均存活率明显高于适当大小移植物。基于提示PVP升高具有很强的预后价值的结果，在手术时开始脾动脉结扎（SAL）。SAL诱导不仅立即减少PVP，但也累积受体存活在小尺寸的移植物是improved.In平行，移植物组织充血进行了研究，使用磁共振成像。80-90%的右侧移植物发生了与眼前段充血一致的形态学变化，而没有进行额外的引流重建。然而，几个月后，大多数移植物的充血逐渐改善。移植物充血与肝功能恶化和PVP升高均无关。然而，一个试探性的，但显着的正相关关系，术后第三或第四周的腹水量和总的移植物充血在第一个month.In结论，PVP升高在早期阶段是密切相关的不良预后归因于小尺寸的移植。然而，SAL诱导PVP的立即和持续降低，并对移植物和患者预后产生积极影响。少

Although living donor liver transplantation (LDLT) has been widely accepted as a treatment of choice for end-stage liver diseases, small-for-size grafts and their pathology leave many controversies in many programs. This study focused on pathogenesis of symptoms associated with small-for-size graft and aimed to establish the effective and safe treatment modality.An antithrombotic catheter was inserted via the inferior mesenteric vein of recipient during operation, and portal vein pressure (PVP) was directly monitored for two weeks after surgery. In small-for-size grafts, compared with appropriate-size grafts, massive ascites, delay of graft regeneration, prolonged coagulopathy and cholestasis were observed commonly. Bacterial translocation possibly attributable either to reduce hepatic reticuloendothelial function or to alter mucosal immunity of intestine occurred in small-for-size grafts. These phenomena closely associated with elevated PVP, and PVP in small-for-size grafts during and … More after operation was significantly higher than that in appropriate-size grafts. Based on the results suggesting that elevated PVP serve a strong prognostic value, splenic artery ligation (SAL) was initiated at operation. SAL induced not only an immediate reduction of PVP, but also cumulative recipient survival in small-for-size grafts was improved.In parallel, graft tissue congestion was investigated using magnetic resonance imaging. Morphologica1 changes compatible with congestion in the anterior segment occurred in 80-90% of right grafts without additional drainage reconstruction. However, congestion improved gradually in most grafts after several months. Graft congestion was associated with neither deteriorated liver function nor elevated PVP. However a tentative but significant positive correlation was observed between amount of ascites in the third or fourth week after surgery and total graft congestion in first month.In conclusion, elevated PVP in the early phase is strongly associated with poor prognosis attributable to small-for-size graft. However SAL induces an immediate and persistent reduction of PVP and gives positive effects on graft and patient prognosis. Less