개의 부분간 자가이식 모델의 확립과 Prostaglandin I2에 의한 허혈간 보호효과

Background: The pathogenesis of primary non function or delayed graft function after liver transplan- tation is not yet clearly defined. However it is presumed that these unhappy events most likely attributes to the Kupffer cell-mediated, reperfusion injury aggravating the sinusoidal endothelial cell damage fol- lowing preformed ischemic insults. Prostaglandin (PG) I and its analogues were reported to protect the liver against ischemic injury thereby be efficacious for the use during the preservation of harvested liver. Prevention of platelet aggregation, vasodilation, stabilization of lysosomal membranes, and inhibition of thromboxane generated by platelets may be the attributable biological activities of PGI. Purposes: We designed this experimental study to assess the effect of continuous PGIz infusion during in situ liver splitting on the bile flow from liver segment during resection and after reimplantation, and to establish our unique autotransplantation model in mongrel dogs before warming-up of living donor partial liver transplantation in the clinic. Methods: Mongrel dogs weighing 15-25 kg were used after fasting for 12 hours. After endotracheal intubation under monitoring, abdomen was opened through the Chevron incision extending to xiphoid process. Initially, the right hepatic duct was ligated and divided. The common bile duct was divided, the end being cannulated proximally and drained. Basal bile flow was measured for 1 hour as a reference value. The left partial graft including the right medial, quadrate, left medial, left lateral lobe, and the papillary process of caudate lobe was resected en bloc. After cold flushing ex vivo, the harvested segment was immediately reimplanted rthotopically. In PGI2 group, PGI2 50 μg was slowly infused through splenic venous cannulation. After closing the abdomen, the bile flow was measured continuously. Results: Eleven out of 24 dogs were alive 12 hours after surgery; 5 in PGI and 6 in control group. Basal mean bile flow (BF) rate were 2.9 rnl/hr/100 gm of liver tissue in control vs. 2.5 ml/hr/100 gm in PGI group. This difference did not reach the statistical significance. However, postoperative BF increased significantly in PGI2 group; 0.45 ml/hr/100 gm in contro vs. 1.71 ml/hr/100 gm in PGI2 group (p 0.04). Conclusion: Continuous infusion of PGI2 through the splenic vein during the harvest of the liver could mitigate the manipulation injury. The BF reflecting the quality of resected liver segment was relatively well preserved in PGI group after canine autotransplantation model. This model is not complicated, and will be useful for the mastery of surgical techniques for the living donor partial liver transplantation in the clinic.