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Development of safety methods for adult to adult living donor liver transplantation focused on cyclic AMP signal pathway.

开发成人对成人活体肝移植的安全方法，重点关注环AMP信号通路。

基本信息

批准号：
13557102
负责人：
FURUKAWA Hiroyuki
金额：
$ 8.77万
依托单位：
HOKKAIDO UNIVERSITY
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (B)
财政年份：
2001
资助国家：
日本
起止时间：
2001 至 2003
项目状态：
已结题

项目摘要

First of all, small-for size graft syndrome is probably due to relative liver ischemia. Although, to dissolve this problem, port-caval shunt, splenic ligation, and splenectomy are used as surgical interventions, there have been few cases treated by pharmacological pre-conditioning. We try to improve liver damage caused by congestion using 2hr-canine warm ischemic model.Secondly, while right lobe grafting is the most effective alternative for the strategy against small-for-size liver syndrome, the suboptimal hepatic venous outflow may lead to serious graft function. The 3 dimensional (3D) images constructed by multiditector CT were used for pre-operative virtual donor hepatectomy and grafting with reconstruction of MHV tributaries. The emphasizing point in our 3D images is that this method can calculate each volume of the are, of which each hepatic vein drains.Thirdly, the reason why we made up clinical pathways for adult to adult living donor liver transplantation is not only for developing theoretical and technical surgical performance, but also for verifying the validity of our patient care strategy in the other liver transplantation programs.Fourthly, the patients after liver transplantation suffered from small-for-size syndrome, basically, need much amount of albumin product, because the ability of the small liver allografts seem to require long time to get mature productivity. In such situation, young surgeons are likely to use much more albumin product than appropriate dose. To lead them to proper direction, we showed our manual haw to use albumin product.Finally, we summarized present status of adult to adult liver transplantation in both Japanese and western countries. In addition, we compared the treatments of graft dysfunction between our program and the others.

首先，小尺寸移植综合征可能是由于相对的肝脏缺血所致。尽管为了解决这一问题，采用了腔静脉分流术、脾结扎术和脾切除术等手术干预措施，但通过药物预处理治疗的病例很少。我们尝试使用2小时犬热缺血模型来改善充血引起的肝损伤。其次，虽然右叶移植是对抗小尺寸肝脏综合征的最有效的替代方案，但肝静脉流出不理想可能会导致严重的移植功能。由多平面 CT 构建的 3 维 (3D) 图像用于术前虚拟供体肝切除术和移植，并重建 MHV 支流。我们3D图像中的重点是，该方法可以计算每个区域的体积，其中每个肝静脉引流。第三，我们之所以制定成人对成人活体肝移植的临床路径，不仅是为了发展理论和技术手术性能，也是为了验证我们的患者护理策略在其他肝移植项目中的有效性。第四，肝移植后的患者患有以下疾病：小尺寸综合症基本上需要大量的白蛋白产品，因为小同种异体肝移植的能力似乎需要很长时间才能获得成熟的生产力。在这种情况下，年轻的外科医生可能会使用比适当剂量更多的白蛋白产品。为了引导他们正确的方向，我们展示了如何使用白蛋白产品的手册。最后，我们总结了日本和西方国家成人对成人肝移植的现状。此外，我们还比较了我们的项目与其他项目之间移植物功能障碍的治疗方法。