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

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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.