A study of split-liver transplantation from brain death donor.

分离式肝移植在日本被认为是一种更容易被接受的肝移植方法。本研究的目的是寻找一种更安全的分离式肝移植的实验模型。本研究采用46只1~1个半月龄的白色猪作为研究对象，包括输血者在内，通过移植物状况评价手术效果。所有手术均在令人满意的全身麻醉下进行。根据手术程序将动物分为两组。其中一组(A组)按活体亲属肝移植供体的手术程序原位切开肝实质；另一组(B组)在后台手术中立即采集肝脏并将其分割。另外，本研究所和北海道大学第一外科在两个不同的机构进行了两例的双侧移植物的同时移植。实验结束后，对两组患者的移植肝表面微循环、生化肝功能及胆汁排泄量的变化进行评估，包括手术结果。结果与结论我们的研究结果表明，切取前的肝实质分离(原位裂解)可以更好地保持移植物的存活。虽然脑死亡供者的状况并不总是足以接受长时间的手术，但我们日本人不得不尝试这种小鼠肝移植，以保持肝脏的广泛应用。

The successful split liver transplantation is considered to be a more acceptable method of liver transplantation in Japan. The purpose of our study is to find a more safety procedure of split liver transplantation using an experimental model. In this study, the operative outcome was evaluated by graft condition compared with operative and preservation.Subject and methodsForty six white porcines, which were aged from one to one and half months, were used for this study including blood spenders. All of the operations were performed under the satisfactory general anesthesia. The animals were divided into two groups by the operative procedure. In one group(group A), the liver parenchyma was split in-situ according to the operative procedure of the donor on the living related liver transplantation. And, the liver was then harvested and completely divided into two grafts.in another group(group B), the livers was immediately harvested and divided on the back table operation. In addition, simultaneous transplantation of both grafts of two cases were performed at two different institutions, our institution and 1st Department of Surgery in Hokkaido University. Following these experiments, the changes of the microcirculation at the graft surface, biochemical liver function test and the amount of bile exertion were evaluated between two groups including operative results.Results and conclusionThe results of our study demonstrated that the division of the liver parenchyma prior to harvest (in-situ splitting) is considered to keep the viability of the graft better. While the brain death donor is not always in condition enough to undergo a long time operation, we in Japan have to try this splig liver transplantation in order to keep widespread application of livers.