猪原位辅助性部分肝移植治疗急性肝功能衰竭的模型

目的建立猪原位辅助性肝移植(APOLT)治疗急性肝功能衰竭的动物模型,并评价其治疗效果。方法选取健康雌性良种幼猪18头,其中12头建立急性肝功能衰竭模型,另6头作为肝移植的供者。将急性肝功能衰竭的幼猪随机平均分为2组:对照组,不作任何处理;实验组,进行APOLT术,切除受者肝脏左叶,将修整后的供肝右叶移植于原肝左叶肝床处,供肝肝上下腔静脉与受者肝肝上下腔静脉行端侧吻合,供肝门静脉与受者肝门静脉行端侧吻合,受者脾动脉在结肠后与供肝动脉行端端吻合,胆总管置管外引流。结果对照组7d生存率仅为17%,而实验组为83%。实验组术后第7d肝功能基本恢复正常,组织学检查示原肝细胞再生明显。结论门静脉注射氨基半乳糖 脂多糖诱导的猪急性肝功能衰竭是一个理想的动物模型;APOLT对急性肝功能衰竭具有较好的疗效。     

大鼠原位辅助性肝移植治疗急性肝功能衰竭

为了评价大鼠原位辅助性部分肝移植（ＡＰＯＬＴ）对急性肝功能衰竭的支持作用。切除７５％的肝脏并阻残余肝脏的血供５０分钟导大鼠急性肝功能衰竭。治疗组受体计切除７５％并将３０％的供肝植于原位，然后阻断残余的右上叶的右下叶之血供５０分钟。结果显示，大鼠急性肝功能衰竭的５天生存率仅３３％，而接受ＡＰＯＬＴ者５天生存率和移植肝存活率分别为８０％和７３％，术后第５天肝功能基本恢复正常。可见，大肝切除和余肝缺血诱     

肝移植治疗猪急性肝功能衰竭的近期疗效和手术体会

目的探讨肝移植治疗猪急性肝功能衰竭的近期疗效和手术要点。方法经门静脉注射0.5g/kg D-氨基半乳糖和1μg/kg脂多糖诱导猪急性肝功能衰竭。实验动物随机分为A、B两组。A组(n=6):不接受肝移植治疗;B组(n=5):接受肝移植治疗。观察两组动物的生化指标、病理改变和1周年存率。结果A组注药后48h血清天冬氨酸氨基转移酶、总胆红素、血氨和凝血酶原时间达最高峰,1周年生存率为17%,肝脏病理检查显示大量肝细胞坏死伴出血。B组受体术后第7d天冬氨酸氨基转移酶、总胆红素、血氨和凝血酶原时间水平基本恢复至正常水平,1周生存率为100%,术后第8d获取的移植肝组织常规病疗猪急性肝功能衰竭的近期疗效肯定。手术成功的关键在于术前受体凝血功能障碍的纠正、术中静脉转流的使用以及可靠的血管重建方法。     

原位肝移植治疗急性肝功能衰竭21例临床分析

目的探讨原位肝移植治疗急性肝功能衰竭的临床疗效。方法回顾性分析天津市第一中心医院21例因急性肝功能衰竭行原位肝脏移植术病人的临床资料，总结急性肝衰竭实施肝移植的经验。结果21例病人随访时间为3～60个月，中位随访时间为25个月。生存时间为1—1530d，中位生存时间为517d。病人的围手术期存活率为66．7％，1年存活率为66．7％，2年存活率为66．7％。死亡原因包括多脏器功能衰竭、颅内出血、上消化道出血、急性成人呼吸窘迫综合征、移植物原发性无功能。14例的远期性生存病人中，13例移植前合并乙型肝炎（乙肝），其中有1例（1／13）在术后1年出现乙肝复发。结论肝移植术是治疗急性肝功能衰竭最有效的方法，严格把握适应证、合理选择手术时机是提高疗效的关键。     

猪改良辅助性部分原位肝移植动物模型建立及麻醉处理

目的 探讨猪辅助性部分原位肝移植模型建立及其术中麻醉处理特点。方法 选10头健康3月龄猪，在气管插管全麻下进行静脉-静脉转流，建立辅助性部分原位肝移植模型；经颈内动，静脉置管监测ABP，CVP；于无肝其，再灌注期抽取血气，血生化，观察血流动力学，内环境变化。结果 实验5例，成活4例；无肝期，再灌注期血流动力学波动明显，并伴有代酸；再灌注期血钾升高明显，体温下降明显，结论（1）本模型成功率高，可为临床应用提供理论依据。值得推广；（2）即使在良好的静脉转流下，无肝期，再灌注期血流动力学，内环境变化仍明显。     

原位辅助性部分肝移植研究进展

原位辅助性部分肝移植作为多模式肝移植的一种分支,以其对患者创伤较小、符合生理、无无肝期等优势日益受到关注,但目前临床尚未较大规模地开展和应用,且原肝和供肝肝细胞再生和门静脉血流之间的功能竞争等问题仍然令人迷惑,尚需更多的临床实践和动物实验来不断地丰富该领域的理论和实践。     

暴发性肝功能衰竭患者施行紧急原位肝移植的进展

自１９８５年Ｉｗａｔｓｈｕｋｉ等首次报告为暴发性肝功能衰竭（ＦＨＦ）患者成功施行紧急原位肝移植（Ｅ－ＯＬＴ）以来，国外数家单位［１～６］相继开展了此项研究。有统计资料表明，ＥＯＬＴ约占同期肝移植总数７％，平均１年存活率达６３％，远高于传统综合支持疗法...     

辅助性部分原位肝移植的研究进展(文献综述)

辅助性部分原位肝移植 (APOL T)是多模式肝移植中的一个重要分支。近年来 ,随着实验及临床研究的不断深入 ,APOL T的适应证及手术方法已趋明确 ,对术后移植肝与宿主肝的功能竞争问题及肝功能评估的研究也有较大进展。     

猪原位辅助性部分肝移植术中血流动力学变化的实验研究

目的:建立一种新的猪辅助性部分原位肝移植模型,并对其血流动力学变化进行观察。方法:选用健康良种幼猪16只,随机配成8对,基础麻醉加气管插管静脉复合麻醉。手术方法:切去供肝左叶,将留存之右叶供肝作移植肝。切除受体之肝左外叶,将右叶供肝肝上、下腔静脉与受肝肝上、下腔静脉行端侧吻合,供肝门静脉与受肝门静脉行端侧吻合,受体脾动脉在结肠后与供体肝动脉行端端吻合,胆总管置管外引流。术中热缺血时间为0min,冷缺血时间为(58±4.0)min。切肝前10min、全肝阻断后10min、供肝植入开放门静脉后10min分别取血检测电解质和全血缓冲碱(BB)及标准碳酸氢根浓度(SB),并观察各个时期的心率(HR)、平均动脉压(MAP)和中心静脉压(CVP)。术后常规处理,未用抗排斥药。部分存活猪在术后5d彩超观察门静脉血流,同时行病理切片检查。结果用均数±标准差表示,采用方差分析和q检验。结果:手术成功率87.5%。术中、术后血流动力学和生化指标均告平稳。术后5d,部分猪彩超结果显示门静脉无血栓形成,仅见移植肝断面有少量包裹性积液,移植肝门静脉最大流速为42.2cm/s,受体肝及移植肝门静脉血流均告通畅。活杀大体及病理切片观察,移植肝形态色泽正常,各吻合口无扭曲、漏血和血栓形成,门静脉无血栓形成。术后5d,活杀取受体肝及移植肝     

辅助性肝移植治疗大鼠急性肝功能衰竭的实验研究

目的探讨辅助性肝移植对急性肝功能衰竭（简称肝衰）的治疗作用。方法在３０只肝功能衰竭大鼠模型上,于原残肝下移植同系异体６２％部分肝脏,手术成功２８例。观察了肝衰组和移植组大鼠存活、血液生化、９９ｍＴｃＨＩＤＡ肝显像、残肝和移植肝组织细胞形态改变。结果肝衰组（１５只）和移植组（２８只）大鼠４８小时存活率分别为０％和７１．４％。移植术后１４天残肝细胞明显增生,肝功能基本恢复正常,辅助肝开始萎缩,术后３０天辅助肝完全纤维化。结论辅助性部分肝脏异位移植可为衰竭之残肝提供暂时性功能支持。原残肝细胞再生,功能恢复过程中辅助肝逐渐萎缩、废用     

Auxiliary partial orthotopic liver transplantation in acute liver failure due to hepatitis B

Auxiliary partial orthotopic liver transplantation is an alternative therapeutic modality in acute liver failure, wherein the capacity of native liver to regenerate is preserved. A case of acute liver failure due to hepatitis B in an 18-year-old male patient treated with an auxiliary left lateral segment graft is described. There was no recurrence of hepatitis B in the auxiliary graft and the patient cleared the virus after 9 months whilst receiving lamivudine. Immunosuppression was withdrawn at 14 months, and the auxiliary graft atrophied secondary to hepatic arterial conduit thrombosis, possibly precipitated by immunosuppression withdrawal. The native liver regenerated completely, and the patient is well and off immunosuppressive and antiviral therapy 3 years after transplantation. Auxiliary partial orthotopic liver transplantation is an attractive treatment option in acute liver failure due to hepatitis B infection and allows a life free of long-term immunosuppression.     

Native hepatectomy after auxiliary partial orthotopic liver transplantation

In countries where a living donor is the only source of the graft, the limited size of the graft is of serious concern when considering extending the procedure to adult recipients. In order to overcome this problem, auxiliary partial orthotopic liver transplantation (APOLT) was applied to the concept that the residual native liver would support the graft function until the graft expanded enough to work by itself. We herein report on a 20-year-old woman with primary sclerosing cholangitis (PSC), who received a small-size liver graft by APOLT. Computed tomography and scintigraphy showed that the graft had regenerated sufficiently 1 month after the operation. The diseased residual native liver is potentially carcinogenetic. Therefore, second-stage native hepatectomy was done 35 days after the first operation. Histopathologic examination of the resected native liver revealed biliary cirrhosis with PSC but no evidence of cholangiocarcinoma. Second-stage native hepatectomy after APOLT seems to be a curative treatment for chronic end-stage liver disease with graft size mismatch that may be as good as orthotopic liver transplantation. Received: 22 October 1998 Received after revision: 15 January 1999 Accepted: 26 February 1999     

Isoniazid-related fulminant hepatic failure in a child: assessment of the native liver's early regeneration after auxiliary partial orthotopic liver transplantation

Abstract We report the first case of auxiliary partial orthotopic liver transplantation (APOLT) in a patient with isoniazid (INH)-related fulminant hepatic failure (FHF) with the aim to determine the ability of the native liver (NL) to recover after this particular toxic event. A 10-year-old boy with INH-related FHF underwent APOLT after left hepatectomy on the NL. Neurological status and liver function rapidly improved, but, on postoperative day 22, urgent re-transplantation was needed for graft-hepatic artery thrombosis (HAT) and the NL's incapacity to sustain adequate liver function. Histological examination of the NL showed signs evident of its regeneration, however. In conclusion, though we faced the clinical failure of the NL functionally to sustain the patient in the presence of the graft HAT 3, weeks after APOLT, such a failure may be interpreted as time related. In fact, the histological picture in this particular case may suggest the potential for NL recovery after INH-related FHF     

The importance of orthotopic liver transplantation in acute hepatic failure

Selection of patients with acute hepatic failure for liver transplantation remains difficult, and there is no definite proof of a survival effect. We therefore did a retrospective study in 75 consecutive patients referred over a 12-year period. In two-thirds we identified a cause, mostly viruses or drugs. Patients were grouped by the Clichy and King's College criteria. In 20 there was no indication for transplantation. Of the 5 with autoimmune hepatitis, 3 died, significantly differing from the other 15 ( P = 0.009). The remaining 55 met our criteria, except 1. All 9 patients with absolute contraindications died. Of the 46 enlisted, 7 died without transplantation. One-year survival after transplantation was 69%, compared with 58% by "intention to treat." For patients enlisted, transplantation reduced mortality by 78% ( P = 0.069). The Clichy and King's College criteria reliably predict survival without transplantation, except in autoimmune hepatitis. Our study strongly suggests that transplantation improves survival.     

Simplified technique for auxiliary orthotopic liver transplantation using a whole graft

Background

Acute liver failure is associated with a high mortality rate and the main purposes of treatment are to prevent cerebral edema and infections, which often are responsible for patient death. The orthotopic liver transplantation is the gold standard treatment and improves the 1-year survival.

Aim

To describe an alternative technique to auxiliary liver transplant on acute liver failure.

Method

Was performed whole auxiliary liver transplantation as an alternative technique for a partial auxiliary liver transplantation using a whole liver graft from a child removing the native right liver performed a right hepatectomy. The patient met the O´Grady´s criteria and the rational to indicate an auxiliary orthotopic liver transplantation was the acute classification without hemodynamic instability or renal failure in a patient with deterioration in consciousness.

Results

The procedure improved liver function and decreased intracranial hypertension in the postoperative period.

Conclusion

This technique can overcome some postoperative complications that are associated with partial grafts. As far as is known, this is the first case of auxiliary orthotopic liver transplantation in Brazil.     

儿童小体积供肝肝移植治疗成人急性肝衰竭1例附文献复习

目的  总结儿童小体积供肝肝移植治疗成人急性肝衰竭的临床经验。方法  回顾性分析1例低龄儿童小体积供肝肝移植治疗成人急性肝衰竭病例的临床资料并进行文献复习。结果  供体为4.5岁儿童,脑死亡器官捐献供肝质量为544.6 g,受体体质量52 kg,移植物受体体质量比为1.05%。手术采用经典原位肝移植术。术后艰难康复,相继并发脑水肿、应激性消化道大出血、急性肾损伤、小肝综合征、肺不张、肺部感染、真菌感染、腹腔感染、胸腔积液等并发症。经对症综合治疗后,移植肝功能逐渐恢复正常,2~3周再生至移植成人标准肝体积大小,住院102 d后康复出院。术后10个月随访受体肝功能正常,生活质量良好。结论  儿童小体积供肝可以成功应用于成人受体,但需要根据供肝情况选择合适的受体、手术方式及围手术期精细管理。     

Auxiliary liver transplantation with arterialization of the portal vein for acute hepatic failure

Six adult patients suffering from acute hepatic failure and with a high urgent status underwent heterotopic auxiliary liver transplantation. In four of these patients, the portal vein of the liver graft was arterialized in order to leave the native liver and the liver hilum untouched and to be able to place the liver graft wherever space was available in the abdomen. The arterial blood flow via the portal vein was tapered by the width of the anastomosis. Two patients died, one of sepsis on postoperative day 17 (POD), the other after 3 months due to a severe CMV pneumonia. There were no technically related deaths. The native liver showed early regeneration in all cases. In one patient, the auxiliary graft was removed 6 weeks after transplantation. Four weeks later, he had to undergo orthotopic retransplantation due to a recurrent fulminant failure of the recovered native liver. This patient is alive more than 1 year after the operation. We conclude that heterotopic auxiliary liver transplantation with portal vein arterialization is a suitable approach to bridging the recovery of the acute failing native liver. Received: 15 September 1997 Received after revision: 4 February 1998 Accepted: 2 March 1998     

Strategies for improving the outcomes of small-for-size grafts in adult-to-adult living-donor liver transplantation

Living-donor liver transplantation (LDLT) has been refined and accepted as a valuable treatment for patients with end-stage liver disease in order to overcome the shortage of organs and mortality on the waiting list. However, graft size problems, especially small-for-size (SFS) grafts, remain the greatest limiting factor for the expansion of LDLT, especially in adult-to-adult transplantation. Various attempts have been made to overcome the problems regarding SFS grafts, such as increasing the graft liver volume and/or controlling excessive portal inflow to a small graft, with considerable positive outcomes. Recent innovations in basic studies have also contributed to the treatment of SFS syndrome. Herein, we review the literature and assess our current knowledge of the pathogenesis and treatment strategies for the use of SFS grafts in adult-to-adult LDLT.