Experimental partial liver transplantation using gradual occlusion of the portal vein for pediatric patient

从心脏跳动的尸体获得的整个肝脏原位置换病变肝脏是肝移植的标准技术。然而，缺乏大小匹配的供体肝脏导致了小儿肝移植的困难。部分杠杆移植是解决这一问题的一种方法。本文介绍了一种新的原位部分肝移植技术，即部分保留受体肝的原位部分肝移植术。我们采用两种不同的方法将受体肝门静脉回流转移到移植肝。将Ameroid缩窄器放置在受体的右门静脉上，以逐渐阻断受体的门静脉流入。结扎右肝管和右肝动脉。本组33只犬中有18只存活超过2 ...更多信息 平均生存期为7.7 ± 5.8天（n=18）。1只犬移植后存活19天。存活时间最长的犬的移植物表现出几乎正常的外观和门静脉周围区域的轻微单核细胞浸润。尸检时移植物的重量增加了一倍。结扎组：结扎受体右侧门静脉，而不是逐渐阻断。11只犬中，8只犬存活超过24小时，平均存活时间为4.5 ± 3.6天（n=8）。逐渐闭塞组的存活率明显高于结扎组。环孢霉素A（5 mg/kg/天）和甲基强的松龙两组均采用1-10 mg/kg/d的剂量作为免疫抑制剂，由于该技术不需要完全阻断腔静脉或门静脉，因此不需要体外静脉-静脉分流，此外，避免了全肝切除，移植失败并不意味着受体的恶化。该方法兼有原位和异位肝移植的优点。少

Orthotopic replacement of the diseased liver by a whole liver obtained from a heart beating cadaver is the standard technique for liver transplantation. However, the shortage of a size-matched donor liver has contributed to the difficulty in pediatric liver transplantation. A partial lever transplntation is one solution of this problem. A new technique of orthotopic partial liver transplantation, which partially retains the host lever, has been developed in the mongrel dog.We pefrormed two different methods for diversion of the portal venous inflow from the recipient's liver to the graft's one.Gradual occlusion group: The left lobe of the donor liver was transplanted orthotopically in the space after removal of the left and central lobes of the recipient. An Ameroid constricotor was placed on the recipient's right portal vein to occlude the recipient's portal inflow gradually. Right hepatic duct and right hepatic artery were ligated. 18 of 33 dogs in this group survived for more than 2 … More 4 hours and the mean survival time was 7.7 5.8 days(n=18). One dog survived for 19 days after transplantation. Graft of the longest survived dog showed almost normal appearance and slight mononuclear cell infiltration in the periportal area. The weight of the graft doubled at autopsy. On the other hand, the recipient's remnant liver revealed atrophy and necrosis of the hepatocyte.Ligation group: The recipient's right portal vein was ligated instead of the gradual occlusion. Of 11 dogs, 8 dogs survived for more than 24 hours and mean survival time was 4.5 3.6 days(n=8). It seemed that the survival rate of the gradual occlusion group was better than that of ligation group.Cycloporin-A(5 mg/kg/day) and methylprednisolone(1-10 mg/kg/day) were used as immunosup-pression in the both groups.Since this technique does not tequire complete occlusion of either caval vein or the portal vein, external veno-venous shunt is unnecessary, Furthermore the total hepatectomy is avoided and graft failure does not mean the recipient's deterioration. This method has the advantages of both patial orthotopic and heterotopoic liver transplantation. Less