The strategies for overcoming the graft dysfunction after liver transplantation using small-for-size graft

(1)医学对肝再生的调节--对肝移植小体积移植物的有利作用。(1)中药银杏叶提取物对大鼠肝切除后肝功能和肝再生的有利作用。ICKT组术后早期转氨酶、TBA、T-Bil水平明显改善。ICKT组术后残肝/体重比明显增加。在ICKT组，术后早期有较强的增殖细胞核抗原和HO-1的表达，但α-SMA的表达较弱。ii)环孢素A在大范围肝切除后的药代动力学：提示活体供肝移植的小体积移植。至于肝再生，则没有明显的差异。关于细胞色素P450…的表达30%移植物模型中3A2表达增多，无明显变化，而细胞色素P3A2表达减少。30%和10%模型肝切除后48h和72h的差异有统计学意义。3)氟伐他汀对大鼠肝脏缺血再灌注损伤的保护作用氟伐他汀可减轻缺血再灌注6h后肝细胞损伤(p&lt；0.05)。氟伐他汀组eNOS基因表达明显高于对照组，而NOX4基因表达明显低于对照组(P<0.05)。此外，氟伐他汀组炎症细胞因子mRNA的表达受到抑制。特别是，氟伐他汀组的肿瘤坏死因子-α显著低于对照组(p&lt；0.05)。(2)高压氧对大鼠大鼠肝切除模型的保护作用HBO-3D组HSP70mRNA的表达明显高于HBO(-)组(P<0.05)。HBO-3D组HSP70和HO-1阳性肝细胞数明显高于HBO(-)组(P<0.05)。70%和90%HX-HBO组转氨酶均显著低于HX单独组(P&lt；0.05)。肝切除后24、48、72小时90%HX-HBO组大鼠LW/BW明显高于90%HX组(P&lt；0.05)。90%HX-HBO组的存活率明显高于90%HX组(P=0.01)。高压氧预处理通过诱导HSP70和HO-1对大鼠肝大部切除模型有一定的保护作用。(3)脾切除对大鼠肝大部切除后肝功能和肝再生的影响。HX+Sp组大鼠存活率明显高于对照组(7d，60%vs18.2%，p&lt；0.05)。肝切除后48h，HX+Sp组ALT、总胆红素迅速改善，差异有统计学意义。肝切除后残肝/体重比值在各时间点均无显著差异。HX+Sp组大鼠肝切除后48h和72h的增殖细胞核抗原标记指数均高于对照组。脾切除可促进大范围肝切除后肝细胞的增殖，改善肝功能，提高存活率。脾切除被认为有利于改善大范围肝切除的预后，大范围肝切除是LDALT中的一种小体积移植模型。较少

(1) Medical modulation on liver regeneration-Beneficial Effects on small-for-size graft in liver transplantationi) Beneficial effects of herbal medicine Inchin-ko-to, on liver function and regeneration after hepatectomy in rats.The survival period was significantly prolonged in the ICKT group. The transaminase and TBA, T-Bil levels significantly were improved in the ICKT group in the early postoperative period. The remnant liver/body weight ratio in ICKT group had been a significant increase postoperatively. In the ICKT group, PCNA and HO-1 was strongly expressed early postoperatively, but the expression of alpha-SMA was weak.ii) Pharmacokinetics of Cyclosporine A after massive hepatectomy : A hint for small-for-size graft in living donor liver transplantationRegarding the blood concentration of CyA, no difference was recognized between 30% and 10% graft model except for 72hrs after Hx. As for liver regeneration, no significant difference was recognized. Regarding the expression of CYP … More 3A2, no change was noted in 30% graft model, on the other hand, CYP3A2 expression reduced. Significant differences were observed in 48 and 72 hrs after hepatectomy between 30% and 10% graft model. The blood concentration of CyA was not dependent on the volume of the liver graft.iii) Beneficial Effects of Fluvastatin on Hepatic Ischemia-Reperfusion Injury in RatsFluvastatin reduced the I/R-induced hepatocellular injury at 6hrs after reperfusion (p<0.05). In the fluvastatin group, the expression of eNOS mRNA was significantly higher, and NOX4 mRNA was significantly lower (p<0.05) than in the control group. Furthermore, the expression of inflammatory cytokines mRNA were suppressed in the fluvastatin group. In particular, TNF-_was significantly lower in the fluvastatin group (p<0.05). This study demonstrated that preoperative administration of fluvastatin had beneficial effects on hepatic I/R injury in rats.(2) Beneficial Effects of Hyperbaric Oxygen Pretreatment on Massive Hepatectomy Model in RatsThe expression of HSP70 mRNA was significantly increased in HBO-3D group compared to HBO (-) group (P<0.05). The HSP70 and HO-1 positive hepatocytes were significantly increased in HBO-3D group compared to HBO (-) group (P<0.05). Transaminases in both 70%-and 90%Hx-HBO group were significantly decreased compared to those of Hx alone group (P<0.05). The Lw/Bw ratio of 90%Hx-HBO group was significantly increased than in 90%Hx group, compared to that of 90%Hx group 24, 48 and 72 hours after hepatectomy (P<0.05). The survival rate in 90%Hx-HBO group was significantly improved than that in 90%Hx group (P=0.01). HBO pretreatment had beneficial effects in massive hepatiectomy model in rats via the induction of HSP70 and HO-1.(3) Effects of splenectomy on liver function and liver regeneration after massive hepatectomy in rats.Survival rate was improved in Hx+Sp group compared with control group (7-days, 60% vs 18.2%, p<0.05). In Hx+Sp group, ALT and total bilirubin were quickly improved 48 hours after hepatectomy, significantly. The remnant liver/body weight ratio after hepatectomy was not significantly different at any time points. PCNA labeling index 48 and 72 hours after hepatectomy in Hx+Sp group was higher than that in control group. Splenectomy promoted hepatocyte proliferation after massive hepatectomy, and improved liver function and survival rate. Splenectomy is considered to be beneficial for improving the outcome in massive hepatectomy, which is a small-for-size graft model in LDALT. Less