Optimal portal venous circulation for liver graft function after living-donor liver transplantation

BACKGROUND: Previous studies have shown poor outcome after living-donor liver transplantation (LDLT) as a result of excessive portal venous pressure (PVP), excessive portal venous flow (PVF), or inadequate PVF. We investigated optimal portal venous circulation for liver graft function after LDLT in adult recipients retrospectively. METHODS: Between June 2003 and November 2004, 28 adult patients underwent LDLT in our institution. We modulated PVP under 20 mmHg in these 28 cases by performing a splenectomy (n=4) or splenorenal shunt (n=1). The PVF and PVP were measured at the end of the operation. Compliance was calculated by dividing PVF by PVP. RESULTS: PVF and compliance showed a significant inverse correlation with peak billirubin levels after LDLT (r = -0.63: r=-0.60, P<0.01), and with peak international normalized ratio after LDLT (r=-0.41: r=-0.51, P<0.05). Compliance was higher in right-lobe graft with middle hepatic vein cases (148+/-27 ml/min/mmHg), and lower in left-lobe graft cases (119+/-50 ml/min/mmHg). CONCLUSIONS: Liver graft function was better when PVF and graft compliance were higher and PVP was maintained under 20 mmHg.     

Impact of portal venous pressure on regeneration and graft damage after living-donor liver transplantation.

Several reports claim that portal hypertension after living-donor liver transplantation (LDLT) adversely affects graft function, but few have assessed the impact of portal venous pressure (PVP) on graft regeneration. We divided 32 adult LDLT recipients based on mean PVP during the 1st 3 days after LDLT into a group with a PVP > or = 20 mm of Hg (H Group; n = 17), and a group with a PVP < 20 mm of Hg (L Group; n = 15). Outcome in the H Group was poorer than in the L Group (58.8 vs. 92.9% at 1 year). Peak peripheral hepatocyte growth factor (HGF) during the 1st 2 weeks was higher in the H Group (L: 1,730 pg/mL, H: 3,696 pg/mL; P < .01), whereas peak portal vascular endothelial growth factor (VEGF) level during the 1st week was higher in the L Group (L: 433 pg/mL, H: 92 pg/mL; P < .05). Graft volume (GV) / standard liver volume (SLV) was higher in the H Group (L / H, at 2, 3, and 4 weeks, and at 3 months: 1.02 / 1.24, .916 / 1.16, .98 / 1.27, and .94 / 1.29, respectively; P < .05). Peak serum aspartate aminotransferase, bilirubin levels, and international normalized ratio after LDLT were significantly higher in the H Group, as was mean ascitic fluid volume. In conclusion, early postoperative PVP elevation to 20 mm of Hg or more was associated with rapid graft hypertrophy, higher peripheral blood HGF levels, and lower portal VEGF levels; and with a poor outcome, graft dysfunction with hyperbilirubinemia, coagulopathy, and severe ascites. Adequate liver regeneration requires an adequate increase in portal venous pressure and flow reflected by clearance of HGF and elevated VEGF levels.     

Impact of a Left-Lobe Graft Without Modulation of Portal Flow in Adult-to-Adult Living Donor Liver Transplantation

In adult-to-adult living donor liver transplantation (LDLT), left-lobe grafts can sometimes be small-for-size. Although attempts have been made to prevent graft overperfusion through modulation of portal inflow, the optimal portal venous circulation for a liver graft is still unclear. Hepatic hemodynamics were analyzed with reference to graft function and outcome in 19 consecutive adult-to-adult LDLTs using left-lobe grafts without modulation of graft portal inflow. Overall mean graft volume (GV) was 398 g, which was equivalent to 37.8% of the recipient standard liver volume (SV). The GV/SV ratio was less than 40% in 13 of the 19 recipients. Overall mean recipient portal vein flow (PVF) was much higher than the left PVF in the donors. The mean portal contribution to the graft was markedly increased to 89%. Average daily volume of ascites revealed a significant correlation with portal vein pressure, and not with PVF. When PVP exceeds 25 mmHg after transplantation, modulation of portal inflow might be required in order to improve the early postoperative outcome. Although the study population was small and contained several patients suffering from tumors or metabolic disease, all 19 patients made good progress and the 1-year graft and patient survival rate were 100%. A GV/SV ratio of less than 40% or PVF of more than 260 mL/min/100 g graft weight does not contraindicate transplantation, nor is it necessarily associated with a poor outcome. Left-lobe graft LDLT is still an important treatment option for adult patients.     

Significance of Portal Venous Velocity in Short-term Graft Function in Living Donor Liver Transplantation

Background

Graft regeneration and functional recovery after reperfusion of transplanted graft are very important for successful living donor liver transplantation (LDLT). The aim of this study was to evaluate the significance of postoperative portal venous velocity (PVV) in short-term recovery of graft function in LDLT.

How transplant surgeons can overcome the inevitable insufficiency of allograft size during adult living-donor liver transplantation: strategy for donor safety with a smaller-size graft and excellent recipient results

Small-for-size grafts are an issue in liver transplantation. Portal venous pressure (PVP) was monitored and intentionally controlled during living-donor liver transplantation (LDLT) in 155 adult recipients. The indocyanine green elimination rate (kICG) was simultaneously measured in 16 recipients and divided by the graft weight (g) to reflect portal venous flow (PVF). The target PVP was <20 mmHg. Patients were divided by the final PVP (mmHg): Group A, PVP < 12; Group B, 12 ≤ PVP < 15; Group C, 15 ≤ PVP < 20; and Group D, PVP ≥ 20. With intentional PVP control, we performed splenectomy and collateral ligation in 80 cases, splenectomy in 39 cases, and splenectomy, collateral ligation, and additional creation in five cases. Thirty-one cases received no modulation. Groups A and B showed good LDLT results, while Groups C and D did not. Final PVP was the most important factor for the LDLT results, and the PVP cutoffs for good outcomes and clinical courses were both 15.5 mmHg. The respective kICG/graft weight cutoffs were 3.5580 × 10(-4) /g and 4.0015 × 10(-4) /g. Intentional PVP modulation at <15 mmHg is a sure surgical strategy for small-for-size grafts, to establish greater donor safety with good LDLT results. The kICG/graft weight value may have potential as a parameter for optimal PVF and a predictor for LDLT results.     

Relationship between portal venous flow and liver regeneration in patients after living donor right-lobe liver transplantation

The purpose of this study is to evaluate the relationship between portal venous (PV) velocity and degree of liver regeneration in humans after living donor liver transplantation (LDLT). Between July 1997 and September 2002, a total of 15 adult-to-adult LDLTs with right-lobe grafts were performed, and 13 of these patients were enrolled in this study. Postoperative PV dynamics differed according to the primary liver disease; therefore, patients were divided into two groups: a fulminant hepatic failure (FHF) group (n = 4) and a liver cirrhosis (LC) group (n = 9). Right-lobe donors (n = 13; D group) were used as controls. Doppler ultrasound was used to measured changes in PV velocity preoperatively; postoperative days (PODs) 1, 3, 7, 14, and 28; and 3 months after LDLT. To assess hepatic regeneration, the increase in liver volume ratio (postoperative liver volume to standard liver volume [SLV]) was measured. PV velocity after LDLT in the LC group increased sharply until POD 7, whereas those in the FHF and D groups were constant. In the first 3 months after LDLT, mean PV velocity was greater in the LC group than the other groups, reflecting the persistent hyperdynamic state in chronic end-stage liver disease. Liver regeneration also was more rapid in the LC group than the FHF and D groups and reached 100% as early as 2 weeks posttransplantation, whereas both the FHF and D livers reached approximately 80% of SLV at 3 months. PV velocity POD 7 correlated significantly with regeneration of the partial-liver allograft at 1 month (r = 0.84; P = .0091). In conclusion, the PV persistent hyperdynamic state in the LC group could directly trigger early liver regeneration in partial-liver allografts after LDLT. (Liver Transpl 2003;9:547-551.)     

Normal hepatic hemodynamics during early postoperative period in recipients with adult live donor liver transplantation

To recognize "normal" hepatic hemodynamics after live donor liver transplantation (LDLT), we analyzed Doppler parameters on recipients with a right liver graft and donors after extended left hepatectomy. Theoretically these values should be the same. From April 2000 to October 2004, 20 LDLTs were performed using a right liver graft. The 10 recipients without postoperative complications and their donors were included in this study. Portal venous velocity (PVV; cm/s), hepatic arterial peak systolic velocity (cm/s), and hepatic venous peak velocity (HVPV; cm/s) were measured during the first 2 weeks. In donors PVV and HVPV after LDLT were significantly higher after than before left hepatectomy: 19.2 +/- 4.2 vs. 31.5 +/- 13.0 cm/s (P = .013) and 23.0 +/- 7.2 vs. 41.8 +/- 10.3 cm/s respectively (P = .010). However, there were mild degrees of increased PVV and HVPV. In recipients, a markedly increased PVV (106.3 +/- 45.2 cm/s on day 1) was significantly higher than that in donors on each postoperative day. The hepatic arterial resistive index in recipients was also significantly higher than that in donors on each postoperative day, for example, 0.72 +/- 0.11 vs 0.62 +/- 0.04 on day 1 (P = .0326). In conclusion, we have shown "abnormal" hepatic hemodynamics in even those recipients without complications during the early postoperative period after LDLT.     

不同门奇断流术式对门静脉高压症犬血流动力学的影响

目的 观察不同门奇断流术式对肝硬化门静脉高压症犬血流动力学的影响.方法 将肝硬化门静脉高压症模型犬32只,随机分为A(传统断流)组、B(选择性断流)组、C(吻合器断流)组及D(对照)组.于术前1周、术后1、6月测定各组犬的门静脉直径(PVD)、门静脉流速(PVV)和门静脉血流量(PVF),于术中、术后1、6月测定各组犬的自由门静脉压力(FPP).结果 术后1月A、B、C组的PVD、PW、PVF均较术前明显降低(P<0.05),其中A组各项指标(0.54±0.03)cm、(11.45±1.27)cm/min、(160.82±30.85)ml/min显著高于B(0.45±0.01)cm、(8.71±0.48)cm/min、(83.37±9.39)ml/min及C组(0.49±0.02)cm、9.85±0.39)cm/min、(111.21±12.68)ml/min(P<0.05),C组显著高于B组(P<0.05).各组术后6月各指标与术后1月比较,差异无统计学意义(P>0.05).D组手术前后差异无统计学意义(P>0.05).A、B、C组手术后FPP均明显下降(P<0.05),其中A组(2.05±0.07)kPa显著高于B组(1.28±0.05)kPa、C组(1.41±0.04)kPa,C组显著高于B组(P<0.05).术后1、6个月,A、B、C组FPP与手术后比较,差异无统计学意义(P>0.05).D组手术前、手术后、术后1、6个月比较,差异均无统计学意义(P>0.05).结论 肝硬化门静脉高压症犬在行传统断流术、选择性断流术和吻合器断流术术后6个月内PVD、PVV、PVF和FPP均显著下降,其中传统断流术影响最小,选择性贲门周围血管离断术最大.     

Risk factors for intraoperative portal vein thrombosis in pediatric living donor liver transplantation

Pathologic changes of the recipient native portal venous system may cause thrombosis of the portal vein, especially in pediatric living donor liver transplantation (LDLT). This study assessed the utility of Doppler ultrasound (US) for the detection of intraoperative portal vein occlusion and identification of predisposing risk factors in the recipients. Seventy-three pediatric recipients who underwent LDLT at Chang Gung Memorial Hospital, Taiwan, from 1994 to 2002 were included. Preoperative and intraoperative Doppler US evaluation of the portal vein was performed. Age, body weight, native liver disease, type of graft, graft recipient weight ratio (GRWR), type of portal anastomosis, portal velocity, portal venous size and presence of portosystemic shunt were analyzed for statistical significance of predisposing risk factors. Eight episodes of intraoperative portal vein thrombosis, with typical findings of absent Doppler flow in portal vein and prominent hepatic artery with a resistant index lower than 0.5 (p < 0.001), were detected during transplantation, which was then corrected by thrombectomy and re-anastomosis. Children age < or =1 yr (p = 0.025), weight < or =10 kg (p = 0.024), low portal flow < or =7 cm/s (p = 0.021), portal venous size < or =4 mm (p = 0.001), and GRWR >3 (p < 0.017) were all risk factors for intraoperative portal vein thrombosis. Doppler US is essential in the preoperative evaluation, early detection and monitoring of outcome of the portal vein in liver transplant.     

Transumbilical portal venous catheterization: a useful adjunct in left lobe living donor liver transplantation

To improve the processes used for perfusion of the explanted graft and measuring the portal venous pressure (PVP) in adult living donor transplantation (LDLT), we performed transumbilical portal venous catheterization (TPVC) to reopen the umbilical vein and insert the catheter for seven adult patients undergoing left lobe LDLT. There were no major complications as a result of this procedure. This procedure prior to implanting the graft was derived from our experience and is a classic diagnostic technique used during liver surgery. It is a simple and effective procedure for perfusion and washout of the graft and for the safe monitoring of the intraoperative PVP. We hope that this technique for left lobe LDLT will be helpful to others using postoperative PVP monitoring, administration of therapeutic drugs through the portal vein, and temporal portal decompression by preparation of extracorporeal shunting in patients with a small‐for‐size graft.     

Measurement of portal venous flow velocity with an implantable miniature Doppler probe in pig liver transplantation

Portal venous flow (PVF) was serially monitored after pig liver transplantation (LTX) with the use of an implantable, miniature Doppler probe developed in our laboratory. Throughout the study period, the mean PVF in pigs that underwent LTX was significantly greater than that in pigs that were sham operated. For three animals with early graft failure secondary to primary nonfunction and for six that survived longer than 7 days, the mean PVF on postoperative day (POD) 1 was 18.7 ± 3.8 cm/s and 41.7 ± 11.2 cm/s, respectively (P < 0.05). For animals with acute cellular rejection (ACR), the mean PVF was 61.3 ± 9.9 cm/s on POD 7 and 54.3 ± 6.38 cm/s on POD 14. These values were significantly higher than those for animals without ACR (P < 0.05). Moreover, the increase in PVF correlated well with the degree of ACR. The actual PVF volume was measured by ex vivo perfusion, which showed a clear correlation with the PVF velocity obtained with the implanted, miniature Doppler probe. We feel that the liver graft requires increased PVF volume after transplantation to facilitate functional recovery from damage to hepatocytes due to preservation-reperfusion injury, and that ACR is also associated with an increased PVF. We conclude that monitoring the PVF in the early postoperative period after LTX is useful in the evaluation of graft function, particularly for predicting primary nonfunction and severity of ACR. Received: 24 June 1996 Received after revision: 24 September 1996 Accepted: 28 October 1996     

Left lobe adult-to-adult living donor liver transplantation: Should portal inflow modulation be added?

Recently, the successful application of portal inflow modulation has led to renewed interest in the use of left lobe grafts in adult-to-adult living donor liver transplantation (LDLT). However, data on the hepatic hemodynamics supporting portal inflow modulation are limited, and the optimal portal circulation for a liver graft is still unclear. We analyzed 42 consecutive adult-to-adult left lobe LDLT cases without splenectomy or a portocaval shunt. The mean actual graft volume (GV)/recipient standard liver volume (SLV) ratio was 39.8% ± 5.7% (median = 38.9%, range = 26.1%-54.0%). The actual GV/SLV ratio was less than 40% in 24 of the 42 cases, and the actual graft-to-recipient weight ratio was less than 0.8% in 17 of the 42 recipients. The mean portal vein pressure (PVP) was 23.9 ± 7.6 mm Hg (median = 23.5 mm Hg, range = 9-38 mm Hg) before transplantation and 21.5 ± 3.6 mm Hg (median = 22 mm Hg, range = 14-27 mm Hg) after graft implantation. The mean portal pressure gradient (PVP - central venous pressure) was 14.5 ± 6.8 mm Hg (median = 13.5 mm Hg, range = 3-26 mm Hg) before transplantation and 12.4 ± 4.4 mm Hg (median = 13 mm Hg, range = 1-21 mm Hg) after graft implantation. The mean posttransplant portal vein flow was 301 ± 167 mL/minute/100 g of liver in the 38 recipients for whom it was measured. None of the recipients developed small-for-size syndrome, and all were discharged from the hospital despite portal hyperperfusion. The overall 1-, 3-, and 5-year patient and graft survival rates were 100%, 97%, and 91%, respectively. In conclusion, LDLT with a left liver graft without splenectomy or a portocaval shunt yields good long-term results for adult patients with a minimal donor burden.     

Initial Clinical Effect of Intraportal Insulin Administration on Liver Graft Regeneration in Adult Patients Underwent Living Donor Right Lobe Liver Transplantation

ObjectiveInsulin is one factor responsible for hepatotrophic regeneration in animal models. This study assessed the clinical effects of intraportal administration of insulin on liver graft regeneration in adult patients undergoing right lobe living donor liver transplantation (LDLT).MethodsBetween July 2005 and September 2007, 19 right lobe LDLT adult recipients voluntarily received posttransplant intraportal insulin administration. The present study describes 15 patients without postoperative vascular and bile duct complications, with more than 1 month survival and with complete clinical data who were enrolled to receive intraportal insulin therapy (group I; n = 15). Another consecutive 15 right lobe LDLT adult recipients without any stimulation regeneration who met the same criteria were enrolled in as noninsulin therapy control group (group NI; n = 15). Group I recipients were treated postoperatively with intraportal insulin infusion, as follows. An 18-gauge catheter was inserted into right gastro-omental vein during surgery, to administer regular insulin just after the operation at the rate of 2 U/h for 1 week. Graft volume (GV) was measured by computed tomography on postoperative days (POD) 7 and 30. Liver functions and serum insulin levels were also measured at POD 7 and POD 30. The liver graft regeneration rate was defined as ratio of posttransplant GV/harvested GV and posttransplant graft-to-recipient weight ratio (GRWR)/operative GRWR.ResultsThe rate defined as ratio of POD 7 GV/harvested GV among group I was significantly greater than that of group NI (186.07 ± 35.40% vs 160.61 ± 22.11%; P < .05). The rate defined as ratio of POD 7 GRWR/operation GRWR was also significantly higher in group I than group NI (178.95 ± 35.84% vs 156.56 ± 18.53%; P < .05), whereas there was no significant difference in terms of regeneration rates at 1 month post-LDLT. Intraportal insulin administration may significantly downregulate POD 7 total bilirubin, aspartate aminotransferase, and alanine aminotransferase levels (P < .05). These results suggested that intraportal insulin administration augmented liver regeneration during the first postoperative week by improving hepatic function in LDLT recipients.     

Factors associated with low graft regeneration in the early phase after living donor liver transplantation

Appropriate graft regeneration after living donor liver transplantation (LDLT) is crucial to avoid small‐for‐size syndrome. We enrolled 44 recipients who underwent ABO‐identical/compatible LDLT from December 2007 to August 2016 and determined possible factors associated with low graft regeneration after LDLT. Liver regeneration was calculated by the ratio of the graft size on postoperative day (POD) 7 ± 1 day (calculated by CT volumetry) to the size of the donated liver at implant. Postoperative outcomes were compared between the low and high regeneration groups. Median regeneration rate was 1.65‐fold. Regeneration rate was negatively correlated with graft‐to‐recipient weight ratio. Postoperative morbidity rates on POD 14‐90 were significantly higher in the low group compared with the high group (63% vs 18%, P = .03). Graft and patient survival in the low group were significantly worse than the high group (1‐year graft survival 73% vs 100%, P = .002; patient survival 82% vs 100%, P = .01). Cold ischemia time (CIT; per 10 minute; odds ratio [OR] =1.37) and platelet count <60 000/μL on POD 5 (OR = 14.32) were independently associated with low regeneration. In conclusion, longer CIT and postoperative thrombocytopenia were associated with low graft regeneration in the early phase after LDLT, which could consequently lead to poor graft and patient survival.     

Factors influencing liver regeneration following living-donor liver transplantation of the right hepatic lobe

BACKGROUND: As a result of the shortage of cadaveric livers for adults, many institutes perform living-donor liver transplantation (LDLT) using right-lobe grafts. It is important to learn whether regeneration of the graft is compromised by division of middle hepatic vein (MHV) tributaries. Accordingly, we studied the effect on graft regeneration of transection of the MHV tributaries and other factors, including graft versus body weight ratio (GRBW). METHODS: Of 100 adult recipients having undergone right-lobe LDLT, 30 6-month survivors were studied. Liver regeneration was assessed by volumetry based on the computed tomography (CT). A regeneration index was defined as the ratio of the graft volume 6 months after LDLT to the preoperative value. The dominance of the MHV tributaries over the right hepatic vein in venous drainage of the anterior segment was evaluated by preoperative CT using a 5-point scale. RESULTS: The regeneration index of the posterior segment was significantly greater than that of the anterior segment (Wilcoxon signed rank test, P=0.01). The relatively poor regeneration of the anterior segment compared with the whole graft was associated with preoperatively dominant MHV tributaries (Spearman rank correlation: R=-0.44, P=0.01). The only significant determinant of the whole-graft regeneration, however, was GRBW (stepwise regression: Y=-0.80X+0.2, R(2)=0.70, P<0.0001). CONCLUSIONS: Despite deprivation of MHV tributaries, a graft will regenerate to meet the metabolic demand, and a smaller graft for the recipient is capable of regenerating to a greater extent.     

Living donor liver transplantation and management of portal venous pressure

Small-for-size syndrome occurs in the presence of a reduced mass of liver that is insufficient to maintain normal liver function. It has been speculated that this dysfunction is principally associated with graft exposure to excessive portal perfusion. The aim of these cases was to evaluate the efficacy of octreotide, a splanchnic vasoconstrictor, and esmolol, a selective beta-blocker, to modify the portal perfusion in the postoperative phase after left living related liver transplantation (LRLT). Four patients who underwent left LRLT with graft-to-recipient weight ratios of 0.60 +/- 0.24 were studied with a catheter placed in a jejunal vein. We observed high basal values of hepatic venous pressure gradient (HVPG) and portal vein flow (PVF). Octreotide infusion decreased HVPG, an effect that was more pronounced when it was combined with esmolol. The administration of both drugs was also associated with an improvement in portal vein oxygen saturation. Despite variation in PVF, the plasma disappearance rate of indocyanin green did not change during the infusion of the two drugs. In conclusion, octreotide and esmolol infusion allowed a manipulation of portal vein pressure that should be measured in left LRLT using a small-for-size graft.     

Liver graft‐to‐spleen volume ratio as a useful predictive factor of the early graft function in children and young adults transplanted for biliary atresia: a retrospective study

A graft volume/standard liver volume ratio (GV/SLV) > 35% or graft/recipient weight ratio (GRWR) > 0.8% has been considered as a standard criteria of graft selection. Even if the graft size meets these selection criteria, small‐for‐size syndrome can still occur depending on the portal venous flow (PVF). The aim of this study was to identify other factors contributing to portal hyperperfusion and the post‐transplant course, focusing on the graft volume‐to‐spleen volume ratio (GV/SV). Thirty‐seven BA patients who underwent living donor liver transplantation were reviewed retrospectively. First, we evaluated the preoperative factors contributing to portal hyperperfusion. Second, we evaluated the factors contributing to post‐transplant complications, such as thrombocytopenia, hyperbilirubinemia, and coagulopathy. The GV/SLV was >35% in all cases; however, portal hyperperfusion (≥250 ml/min/100 g graft) was found in 12 recipients (35.3%). Furthermore, although the GRWR was >0.8% in over 90% of cases, portal hyperperfusion was found in 10 recipients (32.3%). In contrast, the GV/SV showed a significant correlation with the PVF after reperfusion. If the GV/SV was <0.88, about 80% of recipients developed portal hyperperfusion. Furthermore, the GV/SV also showed a significant correlation with post‐transplant persistent thrombocytopenia and hyperbilirubinemia. The GV/SV < 0.88 predicts portal hyperperfusion, post‐transplant persistent thrombocytopenia, and hyperbilirubinemia.     

胰岛素门静脉灌注促进活体肝移植术后肝再生的临床研究

目的 探讨成人活体肝移植(LDLT)术后胰岛素门静脉灌注对移植肝再生的促进作用.方法 2005年7月至2007年9月间接受右肝LDLT并自愿接受术后门静脉胰岛素灌注、有完整临床资料并存活超过30 d的15例成人受者作为研究对象(胰岛素组),同期未接受门静脉胰岛素灌注治疗、有完整临床资料并存活超过30 d的连续15例成人受者作为对照组研究对象(对照组).胰岛素组受者LDLT术中从胃网膜右静脉插入一根18 G硅胶管至门静脉系统,另一端固定于腹壁,术后以2 U/h速度静脉微泵持续均匀门静脉灌注胰岛素7 d.对照组无门静脉插管及胰岛素灌注.LDLT术前1d、术后7 d及30 d检测肝功能与外周血胰岛素水平,术中、术后7 d及术后30 d测量移植肝体积(GV).以GV比例(术后移植肝体积/术中移植肝体积之百分比)和供肝受者体重比(GRWB)比例(术后GRWR/术中GRWR之百分比例)作为移植肝再生检测指标.结果 LDLT术后7d胰岛素组与对照组受者移植肝GV比例分别为(186.1±35.4)%和(160.6±22.1)%,胰岛素组移植肝再生率高于对照组(P<0.05);胰岛素组与对照组受者GRWR比例分别为(179.0±35.8)%和(156.6±18.5)%,胰岛素组移植肝再生率亦高于对照组(P<0.05).LDLT术后30 d胰岛素组与对照组受者移植肝再生率的差异无统计学意义(P>0.05).LDLT术后7 d胰岛素组患者血清总胆红素、丙氨酸转氨酶和天冬氨酸转氨酶水平低于对照组.术后两组患者外周血胰岛素水平及外周胰岛素用量的差异均无统计学意义.结论 LDLT术后胰岛素门静脉灌注可能促进术后第1周移植肝再生.     

成人间活体肝移植后小肝综合征的预防：附6例报告

目的：探讨预防成人间活体肝移植术后小肝综合征（SFSS)的方法。 方法：回顾性分析6例成人间活体肝移植(LDLT)的临床资料,包括受体术前血细胞计数、脾脏厚度、门静脉直径、移植物重量与受体体重比（GRWR）、移植物体积与受体标准肝体积比（GV/SLV）及肝静脉重建等,探讨合适体积移植物、良好肝静脉回流、及正常门静脉灌注对SFSS的预防作用。 结果：受体术前均无严重门静脉高压,均没有采用降门静脉压力与血流的措施,6例肝移植物GV/SLV均大于40%,除1例GRWR为0.74%外,余均大于0.8%。6例受体肝静脉重建均良好,重建后肝脏无淤血改变。术后无SFSS发生。 结论：LDLT通过选择合适体积移植物,重建良好的肝静脉回流,控制门静脉压力,防止门静脉过度灌注等有助于预防SFSS的发生。     

成人间活体右半肝移植术中变异门静脉右支切取与重建技术

目的 探讨成人间活体右半肝移植术中变异门静脉支(APVB)切取与重建的技巧.方法 2002年1月至2007年4月,共实施70例成人间活体右半肝移植.术前肝脏血管三维CT成像显示供肝动脉及静脉走向,70例右半供肝中有9例门静脉分支变异,其中7例为Ⅱ型变异,2例为Ⅲ型变异.除1例供者行狭窄桥状连接单口切取APVB外,其余8例均采用供者优先的原则即距门静脉主干2～3mm处双口切断APVB.Ⅱ型变异中有2例双口切取其右前、右后支成形为一个开口后与受者门静脉主干吻合,4例右前、右后支分别与受者门静脉左、右支吻合,1例行右前、右后支间狭窄桥状组织连接单口切取后与受者门静脉主干单口吻合.Ⅲ型变异中有1例双口切取其右前、右后支分别与受者门静脉支双口吻合,1例双口切取后行新型的U形血管移植物间置与受者门静脉主干单口吻合.结果 9例受者均无门静脉狭窄或血栓、肝动脉狭窄或血栓以及肝静脉流出道狭窄等血管并发症发生.1例供者术后3 d并发门静脉血栓,手术取栓及门静脉壁修补成形后痊愈.新型的U形血管移植物间置重建术后通畅,无并发症发生.结论 成人间活体右半肝移植术中采用供者优先的原则双口切取APVB、双口吻合重建以及新型的U形血管间置等门静脉重建技术是安全可行的,未增加手术难度,且临床效果良好.