生体肝移植における移植肝容積量と自己肝温存同所性生体部分肝移植の開発に関する研究

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We studied the relation between outcomes and graft volume in our living related liver transplantation series and found that the lower limit of the ratio of graft volume to the recipient body weight was 0.8%. In the setting of living related liver transplantation for children using partial liver grafts of parents, the volume of the partial grafts is usually enough for children. In the setting of adult recipients, however, the ratio is often lower than 0.8%, even though we use left lobe grafts including the middle hepatic vein. To solve this problem, we developed auxiliary partial orthotopic liver transplantation, in which the lateral segments or the left lobe of the native liver was removed from a recipient, a partial graft was trnasplanted, and the preserved native liver helped the graft liver until the graft gro** enough. In our experiment using a canine model, we focused on competition between the native liver and the graft liver regarding portal flow and studied the effects of diversion of the portal flow of the native liver. Our results demonstrated that the entire portal flow of the native liver can be diverted safely to the graft. Based on this result, we applied this technique to clinical transplantation and solved the problem of graft size mismatch in adult living related liver transplantation.