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

在我们的活体亲缘肝移植系列中，我们研究了移植物体积与移植物体积的关系，发现移植物体积与受体体重之比的下限为0.8%。在采用父母部分肝移植的儿童活体亲属肝移植的设置中，部分移植物的体积通常足以满足儿童的需要。然而，在成人受体的设置中，这一比例通常低于0.8%，即使我们使用包括肝中静脉在内的左叶移植物。为了解决这一问题，我们开发了辅助性部分原位肝移植，即从受者身上切除自体肝脏的侧段或左叶，部分移植肝被移植，保存的自体肝脏帮助移植物肝脏，直到移植物生长足够。在使用犬模型的实验中，我们重点研究了自体肝脏和移植肝之间关于门静脉血流的竞争，并研究了自体肝脏门静脉血流分流的影响。我们的结果表明，自体肝的整个门静脉血流可以安全地分流到移植物上。基于这一结果，我们将该技术应用于临床移植，解决了成人活体肝移植中移植物大小不匹配的问题。

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.