Study about regulation of liver regeneration by modulating portal venous circulation.

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Excellent liver regeneration after hepatectomy or partial liver transplantation in porcine model was achieved in the group with portosystemic shunt comparing with the group without shunt. The above finding led to the concept that adequate portal venous pressure and flow is essential to obtain good liver regeneration. At the same time, retrospective clinical study for living donor liver transplantation (LDLT) demonstrated that portal venous pressure less than 20mmHg was crucial factor to obtain better clinical outcome with good liver regeneration. At the next step, we performed prospective clinical study of LDLT at Mie University Hospital, in which portal venous pressure was maintained under 20mmHg and sufficient portal venous flow was secured by Doppler ultrasound examination, by means of splenectomy, portosystemic shunt between inferior mesenteric vein and left renal vein, or interception of spontaneous collaterals. As a result, recipient survival was dramatically improved up to 90%. That strategy with modification of portal venous circulation in LDLT had been applied to LDLT at Kyoto University Hospital since 2006, and better outcome (over 90% of recipient survival) has been obtained. In addition, further modification making portal venous pressure less than 17mmHg resulted in better outcome even in recipients receiving small-for-size grafts, defined by low GRWR (graft-recipient weight ratio) ranging from 0.8 to 0.6. As a result, the lowest limit of GRWR in LDLT can be shifted from 0.8 to 0.7, and we can use left lobes rather than right lobes. Changes in graft selection from right lobe to left lobe would contribute to safety of donor operation.