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     

免疫隔离技术在异种肝细胞移植中的应用

目的探讨微囊化猪肝细胞腹腔内移植对药物性肝衰大鼠的治疗作用，观察移植大鼠存活率、肝功能的变化。方法以海藻酸钠体外包裹经胶原酶灌注法分离的乳猪肝细胞，以SD大鼠为受体，D-氨基半乳糖腹腔内注射诱导大鼠急性肝衰竭，48h后将微囊化的猪肝细胞移植于大鼠腹腔内，观察移植大鼠存活率、绘制生存曲线，并测定肝功能的变化。结果腹腔内肝细胞移植可显著改善大鼠肝功能，转氨酶及胆红素均较对照组明显下降（P〈0．05）。与裸肝细胞移植组相比．微囊化肝细胞移植组1周存活率（78．6％ vs 66．7％）及2周存活率（42．9％ vs 25．0％）均显著提高（P〈0．01）。结论对异种肝细胞经微囊化处理后移植治疗急性肝衰大鼠，可给予肝功能代谢支持，提高移植治疗效果。     

大鼠肝细胞肾脏内移植后组织形态与肝功能衰竭治疗作用研究

本实验通过同种异体大鼠肝细胞肾脏内移植，尝试在受体体内建立第二肝脏。对移植肝细胞进行长期组织形态与功能观察，并利用该方法进行急性肝功能衰竭肝功能辅助支持治疗研究。结果表明肝细胞肾脏内移植后可长期存活、增殖而且具有肝组织结构重建及保持肝脏功能的能力。４×１０７个肝细胞肾脏内移植后可显著提高受体大鼠对肝功能衰竭的承受力，移植组术后３天行９０％肝切除诱发急性外科型肝功能衰竭后其存活率显著高于对照组。以上结果显示肾脏可以成为肝细胞移植又一适宜部位，肝细胞肾脏内移植有可能成为临床上肝脏代谢及功能障碍疾病的一种治疗手段。     

大鼠原位辅助性部分肝移植

本研究旨在建立大鼠原位辅助性部分肝移（ａｕｘｉｌｉａｒｙｐａｒｔｉａｌｏｒｔｈｏｔｏｐｉｃｌｉｖｅｒｔｒａｓｐｌａｎｔａｔｉｏｎ,ＡＰＯＬＴ）模型,进一步推动肝移植的实验和临床研究。在半肝血流阻断下切除受体肝脏的７５％。然后将３０％的供肝移植于原位。作者成功地施行大鼠原位辅助性部分肝移植４０次。受体５天生存率为８７．５％。移植肝５天存活率为７５％。术后第５天移植肝重量增加一倍,肝细胞增生活跃,ＤＮＡ呈二倍体,ＤＮＡ合成期肝细胞占２２．６％±２．７５％明显高于正常肝细胞的１２．２２％±１．４８％（Ｐ＜０．００１）。作者认为,大鼠ＡＰＯＬＴ是一个较理想的动物模型。     

白细胞介素-6在辅助性肝移植肝脏功能竞争中作用的实验研究

目的：探讨白细胞介素－6（IL－6）在辅助性部分异位肝移植后两肝功能竞争中的作用。方法：Wistar大鼠分3组：正常对照组（A组）(n=10)：抽下腔静脉血0.5ml做为正常对照，另两组为手术组，均采用Hess法。手术实验组（B组）(n=10)，切除受体大鼠肝的左外叶（32％）和乳头叶（10％）行辅助性部异位肝移植（APHLT）手术，移植肝门静脉与受体的肠系膜上静脉行端－端吻合。手术对照组（C组）(n=10)：切除受体右肾，保持受体原肝完整无损，移植肝手术同手术实验组。观察关腹时和手术后1－4d下腔静脉和门静脉血IL－6含量变化以及术后4d的移植肝脏病理变化。结果：（1）IL－6水平手术实验组明显升高，手术对照组升高不明显，两组间存在显性差异（P＜0．05）。（2）术后手术实验组移植肝组织增生，手术对照组移植肝萎缩。结论：移植肝的增生与IL－6的水平密切相关。当辅助性肝移植受体肝脏部分切除后IL－6水平升高，刺激移植肝增生；当辅助性肝移植肝脏完好无损，IL－6水平不升高，移植肝因缺乏增生刺激而萎缩。APHLT的两肝功能竞争的本质可能是由肝脏增生的不同刺激途径诱导决定的。     

长期冻存对微囊化肝细胞形态结构功能的影响及在急性肝功能衰竭中的治疗作用

目的　研究长期液氮冻存对微囊化肝细胞结构和功能的影响。方法　将３ 组 Ｓ Ｄ 大鼠微囊化肝细胞分别用液氮冻存１５ 、３０ 、６０ 天后,检测肝细胞活率、结构、功能及其对急性肝衰的初步治疗效果。结果　冻存后３ 组的细胞活率分别为（７２ ．７５ ±３ ．９） ％ 、（７０ ．０７ ±５ ．６８） ％ 、（７２ ．３９ ±１３ ．７５） ％ ;肝细胞的形态结构正常;肝细胞葡萄糖６磷酸酶、糖原及白蛋白染色正常,培养４ 天后各组的总蛋白和尿素氮的合成分泌功能与新鲜微囊化肝细胞差异无显著性（ Ｐ＜ ０ ．０１） 。冻存组（１５ 天组） 腹腔移植能明显提高急性肝功能衰竭模型大鼠的存活率５５ ％ （１１／２０） ,与裸细胞组（３３ ％ ,８／２４） 及空囊组（１６ ．６ ％ ,５／３０） 相比差异有显著性（ Ｐ＜ ０ ．０１） 。结论　液氮可良好的保存微囊化肝细胞的形态结构及功能;冻存微囊化肝细胞腹腔移植有良好的肝功能支持作用。     

无门静脉重建异位肝移植治疗慢性肝功能衰竭大鼠的实验研究

目的探讨单纯肝动脉重建异位肝移植在胆总管断扎所致慢性肝功能衰竭大鼠中的应用。方法试验分成3组:胆总管断扎组(DBD组,10只),胆总管断扎同时行单纯肝动脉重建的异位肝移植组(DBD+HLT组,15只)和单纯肝动脉重建的异位肝移植组(HLT组,15只)。术后第3,7,14,21,28,35,105天分别从尾静脉取血进行血清胆红素(T-Bil),谷草转氨酶(GOT)和碱性磷酸酶(ALP)测定,第5周分别处死HLT组和DBD+HLT组中各5只大鼠,切取异位移植肝脏称重比较。长期生存大鼠受体肝脏,异位移植肝脏进行病理检查。结果虽然单纯肝动脉重建异位肝移植没有使大鼠血清肝功能化验指针保持正常,但是明显改善了胆总管断扎大鼠的生存率。术后第35天时DBD+HLT组移植肝(11.2±5.3)g明显重于HLT组(2.5±0.5)g(P<0.01)。病理检查显示:HLT和DBD+HLT组中移植肝均呈正常肝小叶结构,但是,DBD+HLT组可见移植肝细胞水样变性,受体肝脏呈弥漫性胆管增生,肝细胞仅呈岛状残留。结论单纯肝动脉重建异位肝移植明显改善了胆总管断扎大鼠的生存率,与受体肝脏的功能竞争而不是有无门静脉血供是决定异位移植肝脏是否萎缩的主要因素。     

异种肝细胞移植防治大鼠急性肝功能衰竭

目的: 探讨异种肝细胞移植对大鼠急性肝功能衰竭的治疗效果. 方法: 切除大鼠90%肝脏,建立急性肝功能衰竭模型.分离异种豚鼠和同种异体Sprague-Dawley鼠肝细胞,切肝术前1天植入受体脾脏内.观察受试大鼠存活时间、切肝术后24小时血生化改变和脾脏切片表现. 结果: ①中位存活时间,对照组为21小时,同种组为56小时,异种组为40小时.同种组存活时间较对照组长(P<0.01),异种组亦延长(P<0.05).②移植组部分血生化指标有所改善.异种组中仅血糖和凝血酶原时间改善较明显(P<0.05),同种组中谷丙转氨酶、总胆红素、血糖和凝血酶原时间都有明显改善(P<0.05或P<0.01).③肝细胞植入后48小时,异种组脾脏内仅存少量萎缩的肝细胞,同种组脾脏内仍散在健存肝细胞. 结论: 异种肝细胞移植对大鼠急性肝功能衰竭有防治作用;要提高移植效果,首先需克服早期的免疫排斥.     

药物性肝衰大鼠脾内移植异种肝细胞治疗前后的CD4，CD8的变化及意义

为探讨异种肝细胞脾内移植治疗大鼠药物性肝衰的意义，观察大鼠肝功能、存活率及ＣＤ４，ＣＤ８在免疫排斥反应中的作用。笔者以豚鼠肝细胞为供体，ＳＤ大鼠为受体，Ｄ-氨基半乳糖(１９.５ml/㎏)腹腔内一次性注射，制作肝衰模型。４８h后将微囊化的游离豚鼠肝细胞移植于大鼠脾脏内。以豚鼠裸肝细胞移植及生理盐水脾脏注射为对照。移植后１４d测定存活率和肝功能，检查病理切片及ＣＤ４，ＣＤ８的变化。结果示微囊化肝细胞移植组存活率８０.0％，明显高于生理盐水组（２５.0％）和裸肝细胞移植组（７０.0％）（分别为P<０.０１和P<０.０５）。微囊肝细胞移植组１４ｄ总胆红素和ＡＬＴ，明显低于生理盐水组和裸肝细胞组。移植后７２ｈ和１４ｄ分别测定受体脾脏ＣＤ４，ＣＤ８淋巴细胞，移植后７２ｈ，１４ｄ微囊化肝细胞组、裸肝细胞组CD4，CD8均呈阳性。提示：大鼠药物性肝衰微囊化肝细胞脾内移植后可维持受体存活１４ｄ，体液和细胞免疫均参与排斥反应。肝细胞微囊化处理可延迟细胞免疫的发生时间。     

微囊化同系、同种异体、异种肝细胞腹腔移植对急性肝衰的治疗作用

目的 探讨微囊化同系、同种异体、异种肝细胞腹腔移植对急性肝衰（ａｃｕｔｅ ｌｉｖｅｒ ｆａｉｌｕｒｅ,ＡＬＦ）的治疗作用。方法 切除大鼠９０％的肝脏,建立急性肝衰模型;分离纯化包裹同系Ｗｉｓｔａｒ鼠,同种异体ＳＤ鼠及异种豚鼠的肝细胞。移植到受体模型鼠腹腔内,观察微囊存活情况及肝衰鼠的生存率和生化改变。结果 在４８ｈ内对照组存活率仅１５．４％,而同系肝细胞组为７８．６％,ＳＤ微囊组７３．３％,ＧＰ微囊组６２．５％,７ｄ后对照组大鼠全部死亡,而其余３组存活率分别为５７．１％,、５３．３％、５０．０％。微囊化肝细胞组ＡＬＴ和ＴＢＩＬ的水平明显降低,与对照组相比差异有非常显著性（Ｐ〈０．０１）。结论 微囊包裹同种异体和异种肝细胞腹腔移植而不使用免疫抑制剂,能够阻止免疫排斥反应,给予肝功能代谢支持,阻止急性肝衰模型鼠的死     

大鼠小体积肝移植后肝细胞再生的研究

目的 探讨小体积肝移植术后肝再生的情况。方法 建立大鼠30％原位肝移植模型,实验分为肝切除（PH）组、全肝移植（0LT）组和30％小体积肝移植（30％POLT）组,观察1w生存率,并于术后1、2、3、7d检测肝细胞增殖活性、肝功能和肝组织学变化。结果 各组1w生存率均为100％;30％POLT组术后2d达到增殖高峰,峰值与PH组无差异（P〉0．05）;其肝功能酶学指标在术后1、3d明显升高,组织学见肝细胞核分裂极其活跃。结论 冷缺血1h的30％供肝和肝切除后肝脏具有同样的增殖活性,仅增殖高峰稍晚;较短的冷缺血时间以及熟练的手术技术可能对小体积供肝的再生起重要作用。     

感染肝吸虫的肝脏作为移植供肝的可行性(附14例报告)

目的 探讨感染肝吸虫的肝脏作为移植供肝的可行性.方法 14例肝功能衰竭患者接受感染肝吸虫的供肝移植.均为尸体供肝,供者生前均未诊断肝吸虫病,肝功能正常.供肝均采用快速切取技术获取,用UW液灌洗、保存,供肝热缺血时间为(4.0±2.1)min,冷缺血时间为(582±167)min.肝脏保存之后在供肝胆管中发现肝吸虫成虫,由此确定供肝感染肝吸虫.14例患者均接受经典原位肝移植术,常规留置T管.术后2～4d开始给予吡喹酮,每天3次,每次25mg/kg,2d 为一个疗程.采用他克莫司、霉酚酸酯和肾上腺皮质激素联用预防排斥反应.观察患者生存状况、早期肝功能恢复情况以及胆管并发症发生率.术后第7天和3个月留取胆汁,涂片找肝吸虫虫卵.结果 移植前1例供肝存在小叶间胆管轻度增生,1例为轻度大泡性脂肪肝(5%),其余供肝组织均正常.术后随访时间中位数为31个月,移植物1年和3年存活率分别为85.7%和78.6%.所有患者术后早期肝功能均迅速改善,无移植物原发无功能或功能恢复延迟出现.术后发生胆管并发症2例(14.3%,2/14),1例为肝内胆管狭窄(术后3个月),另1例为胆总管结石(术后2年).术后全部患者的胆汁中均未发现肝吸虫虫卵.结论 感染肝吸虫的肝脏可以作为移植供肝,但此类供肝的选择标准尚待探讨.     

ABO BLOOD GROUP INCOMPATIBILITY IN LIVER TRANSPLANTATION: A SINGLE-CENTRE EXPERIENCE

Background : For most organ transplantation (Tx), ABO blood group incompatibility (ABOI) is an absolute contraindication because of the high incidence of hyperacute rejection (HAR). While HAR occurs in ABOI liver Tx (LTx), it is known that some liver grafts can be accepted. Methods : ABO-incompatible (ABOI) liver allografts were used in seven of 355 orthotopic LTx operations performed at our institution over a 10-year period. All seven recipients were in fulminant hepatic failure (FHF) prior to Tx. Results : Following Tx, all grafts functioned immediately. One patient died without recovering consciousness. Six patients recovered consciousness following Tx but three patients subsequently required re-transplantation (with ABO-compatible grafts (ABOC)) because of severe acute rejection (2) and chronic rejection (1). Hyper-acute rejection did not occur. All six patients are now well, with a mean survival of 61.5 months. When compared to 36 other FHF patients who received ABOC grafts, graft survivals were 3/7 (43%) for ABOI versus 23/36 (64%) for ABOC (P= not significant (NS)). Patient survivals were 6/7 (85.7%) for ABOI patients and 23/36 (64%) for ABOC (P= NS). The re-transplantation rate was significantly higher in the ABOI group (P= 0.001). Conclusions : The results confirm that ABOI liver grafts should be used in urgent circumstances when compatible grafts are not available. Some grafts function indefinitely, while those that fail may function for sufficient time to allow successful re-transplantation with ABOC grafts.     

Predictors of clinical outcome in children undergoing orthotopic liver transplantation for acute and chronic liver disease.

The current United Network for Organ Sharing (UNOS) policy is to allocate liver grafts to pediatric patients with chronic liver disease based on the pediatric end-stage liver disease (PELD) scoring system, while children with fulminant hepatic failure may be urgently listed as Status 1a. The objective of this study was to identify pre-transplant variables that influence patient and graft survival in those children undergoing LTx (liver transplantion) for FHF (fulminant hepatic failure) compared to those patients transplanted for extrahepatic biliary atresia (EHBA), a chronic form of liver disease. The UNOS Liver Transplant Registry was examined for pediatric liver transplants performed for FHF and EHBA from 1987 to 2002. Variables that influenced patient and graft survival were assessed using univariate and multivariate analysis. Kaplan-Meier analysis of FHF and EHBA groups revealed that 5 year patient and graft survival were both significantly worse (P < 0.0001) in those patients who underwent transplantation for FHF. Multivariate analysis of 29 variables subsequently revealed distinct sets of factors that influenced patient and graft survival for both FHF and EHBA. These results confirm that separate prioritizing systems for LTx are needed for children with chronic liver disease and FHF; additionally, our findings illustrate that there are unique sets of variables which predict survival following LTx for these two groups.     

Effect of graft steatosis on liver function and organ survival after liver transplantation

BACKGROUND: It was the aim to determine the effect of graft steatosis on intraoperative organ blood flow, postoperative liver function, and organ survival. METHODS: A total of 225 consecutive liver transplants were reviewed. Liver blood flow, hepatic function (AST, ALT, prothrombin time), and organ survival were determined. Donor liver grafts were categorized into 2 subgroups: mild (<30%) (n = 175) and moderate to severe (>/=30%) (n = 50) macrovesicular steatosis. RESULTS: Moderate to severe steatosis was associated with significantly increased AST and ALT levels and significantly diminished prothrombin time on the first and second postoperative day. By day 7 differences in liver function were no longer evident. Organ blood flow was not affected by steatosis. After adjustment for potential confounders, organ survival did not depend on the degree of donor steatosis (5-year-survival rates: 68% and 58% with steatosis <30%, or >/= 30%, respectively) (hazard ratio .754, confidence interval .458-1.242, P = .268). CONCLUSION: Steatotic livers can be transplanted safely with good results for long-term organ survival if other contraindications are absent.     

大鼠30%小体积肝移植模型手术技巧

目的 建立稳定、理想的大鼠30%体积肝移植模型.方法 二袖套法和体内切肝法建立非动脉化30%体积肝移植模型,对100只SD大鼠施行50例30%体积肝移植(10例前期操作,不列入统计),对手术操作技巧和细节、术后存活及原因等进行探讨.结果 手术成功率100%(40/40),术后1周、2周存活率均40%(16/40),死亡原因主要为肝功能失代偿、胆管梗阻或胆漏、肝上下腔静脉血栓形成、肝叶坏死和腹腔感染等.结论 30%体积肝移植模型改进后供肝残面出血率低,机械损伤小,供肝再灌注色红均匀,存活率好,可作为小体积肝移植有关实验研究的动物模型.

Abstract：

Objective To establish a reliable and ideal model of 30% size graft liver transplantation in rats. Methods The model of 30% size graft liver transplantation in vivo was established by using male SD rats according to Kamada's two-cuff method. The operative techniques and ditails, and survival rate were explored and analyzed. Results The rate of successful surgery was 100% (40/40). The one- and two-week survival rate both were 40% (16/40), and the causes of deaths included liver function decompensation, bile duct stenosis or bile leakage, thrombosis of super inferior vena cava, liver necrosis and celiac infection.Conclusion Improved model of 30% small-for-size liver transplantation had a low hemorrhage rate of residual liver surface, reduced mechanical damage in small-for-size graft, high success rate and survival rate, and was an ideal animal model on the study of experiments related to the small-for-size liver transplantation.     

Directing portal flow is essential for graft survival in auxiliary partial heterotopic liver transplantation in the dog.

BACKGROUND/PURPOSE: Auxiliary liver transplantation is an attractive alternative for orthotopic liver transplantation in patients with certain inborn errors of metabolism of the liver in which complete resection of the liver is unnecessary or even contraindicated. Because in these diseases portal hypertension is mostly absent, finding a balance in portal blood distribution between native liver and graft is complicated. The objective of this study was to investigate requirements for long-term (180 days) graft survival in auxiliary partial heterotopic liver transplantation (APHLT) in a dog model. METHODS: A metabolic defect was corrected in 26 dalmation dogs with a 60% beagle heterotopic auxiliary liver graft. Four groups of different portal inflow were studied. In the ligation group the portal vein to the host liver was ligated. In the split-flow group graft and host liver received separate portal inflow. In the banding group the distribution of the portal flow was regulated with an adjustable strapband and in the free-flow group the portal blood was allowed to flow randomly to host or graft liver. RESULTS: Metabolic correction increased in all groups after transplantation from 0.19 +/- 0.02 to 0.70 +/- 0.05 (P< .0001) but remained significantly better in the ligation and split-flow groups (graft survival, 135 +/- 27 and 144 +/- 31 days). In the banding group metabolic correction decreased significantly after 70 days, and although the grafts kept some function for 155 +/- 14 days, in 4 of 6 dogs portal thrombosis was found. In the free-flow group, competition for the portal blood led to reduced correction within 12 days and total loss of function in 96 +/- 14 days. Graft function also was assessed with technetium (Tc) 99m dimethyl-iminodiacetic acid uptake. A good linear association between HIDA uptake and metabolic correction was observed (r = 0.74; P < .0005). Grafts that contributed more than 15% to the total uptake of HIDA showed biochemical correction. This indicates a critical graft mass of about 15% to 20% of the hepatocyte volume to correct this metabolic defect. CONCLUSION: Auxiliary partial heterotopic liver transplantation can be a valuable alternative treatment for inborn errors of hepatic metabolism if the native liver and the graft receive separate portal blood inflow.     

Posttransplant survival in pediatric fulminant hepatic failure: the SPLIT experience.

Pediatric patients with fulminant hepatic failure (FHF) tend to be the sickest and have the most urgent need for a liver transplant. The purpose of this analysis was to identify factors associated with posttransplant survival in this subset of patients. Data on all FHF patients registered in the Studies of Pediatric Liver Transplantation (SPLIT) registry from 1995 to 2002 were analyzed. Demographics such as age, gender, race, weight, and etiology of liver disease were recorded. Pretransplant degree of encephalopathy; intubation; dialysis; laboratory parameters such as serum bilirubin and international normalized ratio of coagulopathy (INR); and type of graft: cadaveric whole, cadaveric technical variant, or living donor were analyzed to determine effects on patient survival. Overall, FHF accounted for 12.9% (141 / 1,092) of primary transplants performed between 1995 and 2002. The etiology of liver disease was unknown in the vast majority of children (126 / 141; 89.4%). Mortality while on the waiting list for FHF children is significantly higher than for children with other liver disease (P < .0001). Six-month survival posttransplant for patients with FHF (74.5%) is significantly lower (P < .0001) than those with chronic liver disease (88.9%). A multivariate model demonstrates that the highest risk group includes those children with grade 4 encephalopathy (P < .0001), infants less than 1 year of age (P = .018), and children requiring dialysis prior to transplantation (P = .002). Pretransplant bilirubin and INR were not significant predictors of posttransplant survival after controlling for the other significant factors. Living donor and split / reduced grafts did not have a significantly increased risk of posttransplant death compared to whole grafts. In conclusion, despite advances in the surgical techniques and changes in organ allocation, pediatric patients with FHF continue to have a high pretransplant mortality and less successful posttransplant survival compared to children with chronic liver disease.     

肝移植中边缘供体使用经验的初步探讨

目的:探讨肝移植中使用边缘供肝〔包括脂肪供肝、寄生虫供肝、HCV(+)供肝和HBsAg(+)供肝〕对术后肝功能和预后的影响。方法:分析中山大学附属第一医院近5年采用UW液体灌注供肝的首次肝移植患者85例的临床资料。其中边缘供肝44例（35例脂肪肝, 6例寄生虫肝, 2例乙肝, 1例丙肝）, 正常供肝41例(对照组)。35例脂肪肝供肝依据脂肪变性程度分3组, 分别比较各组肝移植术后当天,术后1,2,3,7 d血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素（TB）水平、凝血酶原时间（PT）、ICU 时间、迟发性无功能（DNF）发生率和3, 6个月患者生存率等指标。对6例寄生虫供肝术后行B超严密观察, 对1例HCV(+)和2例HBSAg(+)供肝受体术后血清检测及其对预后影响进行分析。结果:脂肪变≥40%组的术后ALT, AST, TB, PT均高于脂肪变20%～40%组（P＜0.05）; 脂肪变20%～40%组术后AST, ALT, TB均高于脂肪变＜20%组（P＜0.05）; 供肝脂肪变＜20%组与对照组比较差异无显著性; 脂肪肝供肝各组术后迟发性无功能发生率和3,6个月存活率均无统计学差异。寄生虫供肝、HCV(+)及HBV(+)供肝未增加术后病死率。结论:供肝脂肪变＜20%者作为供肝较安全; 随着供肝脂肪变性程度的加重, 移植术后肝衰竭风险增大; 对脂肪变≥40%供肝应慎重或避免使用。在没有合适供肝的紧急情况下, 可考虑使用寄生虫供肝、HCV(+)和HBV(+)供肝。     

Feasibility of Auxiliary Partial Living Donor Liver Transplantation for Fulminant Hepatic Failure as an Aid for Small-for-Size Graft: Single Center Experience

Auxiliary partial orthotopic liver transplantation (APOLT) or heterotopic auxiliary partial liver transplantation (HAPLT) was initially indicated for potentially reversible fulminant hepatic failure (FHF). We started auxiliary partial living donor liver transplantation (LDLT) for FHF in February 2002. Since then, 5 FHF patients (3 females and 2 males) underwent auxiliary partial LDLT: 3 cases of APOLT and 2 cases of HAPLT. All of them received a small-for-size graft: graft-to-recipient weight ratio (GRWR) ≤ 1.0%. The etiologies of FHF were hepatitis B virus (HBV) in 1, Wilson's disease in 1, and unknown origin in 3 cases. Three were the acute type and 2 the subacute type of FHF. Median age was 45 years (range, 14-54 years). Blood type was identical in all cases. A left lobe graft was used in 4 instances and a right lobe graft in 1 case. Median GRWR was 0.74 (range, 0.42-0.85). Median follow-up was 42 months (range, 3 days to 70 months). Three of 5 patients (60%) were alive (at 42, 67, and 70 months) and 1 was free of immunosuppression after sufficient recovery of the native liver. Two cases succumbed: 1 at postoperative day 3 because of cytomegalovirus pneumonia and 1 at 10 months after APOLT because of sepsis. Complications were seen in all 5 patients: Relaparotomy for hemostasis in 3, decompression surgery of the abdominal cavity in 1, rehepaticojejunostomy in 1, and biliary strictures in 2 cases. Auxiliary partial LDLT may be a choice as an aid for a small-for-size graft in FHF.