PERIOPERATIVE HEMODYNAMIC CHANGES INADULT LIVING DONOR LIVER TRANSPLANTATION

成人活体肝移植围术期血流动力学变化

• 批准号: 18591409
• 负责人: YOSHIMURA Norio
• 金额: $ 2.37万
• 依托单位: Kyoto Prefectural University of Medicine
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2006
• 资助国家: 日本
• 起止时间: 2006 至 2007
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-18591409/
• 关键词: hemodynamics; living donor liver transplantation; renal function; ICG test; 過小グラフト; 腎機能検査; ICG試験; 移植肝機能; 周術期管理; 循環動態; 非採血型循環機能検査装置; hyperdynamic state; 心係数

Indocyanine green (ICG) can be used to measure cardiac output, index (CI), hepatic function, and blood volume. We used ICG to evaluate the effect of living donor liver transplantation (LDLT) for patients of end-stage liver diseases (ESLD) on perioperative hemodynamic changes and renal functions. Patient and Method: ICG examination was performed 20 adult LDLT in perioperative stage. Futhermore, examinations and were performed preoperative, immediate after LDLT (day 0), postoperative day (POD) 1, 2, 3, 7, 10, 14, 21 and 28. ICG elimination test was performed by spectrophotometric method and a noninvasive finger or nose-piece method. And renal function test including serum and urineβ2- microglobulin (BMG), fractional excretion of sodium (FENa), 24 hours creatinine clearance value(CCr), serum creatinine value(Cr), N-acetyl-β-D-glucosaminidase(NAG) value were measured at same time.Result: CI was significantly higher until POD 10 than before LDLT (4.303ア1.294 vs 3.165±0.999 1/min/m^2: P<.05) … More . After POD 14, CI was not significantly different between preLDLT and normalized(POD 14: 3.136±1.092, CI normal range 3-4 1/min/m^2). As regards renal function tests, when compare each factor by preoperative the 14th disease day, as CCr fall 75.9± 34.2 (ml/min) to 46.1±19.6. NAG shows 17.6±12.1(U/ to 14.0±11.6, it means the proximal tubule disorder. As for urine BMG shows729.9±2012.5 (μg/I) to 939.21±431.3, it means that the renal tubule and glomerulus disorder. FENa shows 1.2±1.1 (%) to 1.0±0.7, it does not show a change. Cr shows 1.2±1.1 (mg/dl) to 0.7±0.3, as for Cr, it improved.Conclusion: The characteristic of hemodynamics in ESLD patients is extremely large cardiac output, so-called hyperdynamic state. In this study, CI was significantly higher until POD 10 than before LDLT. Therefore, we think that hyperdynamic stage continue the minimum 10 days after LDLT. Although Cr value improved by LDLT, patent renal disorder existed, example for NAG and BMG value elevation. Although it was thought that the ICG test was extremely useful evaluation method for the circulation change of ESLD patient on perioperative period management, the improvement of the circulation change it doesn't necessarily mean improvement of the renal function. Therefore, we should have considered the factor except the circulation change when we thought about LDLT patient's renal function. Less

吲哚菁绿（ICG）可用于测量心输出量、指数（CI）、肝功能和血容量我们使用ICG来评估终末期肝病（ESLD）患者活体肝移植（LDLT）的效果。 ) ) 围手术期血流动力学变化和肾功能 患者和方法：对 20 名成人 LDLT 在围手术期进行了 ICG 检查，并且在术前、LDLT 后立即进行了检查。 0），术后第1、2、3、7、10、14、21和28天。采用分光光度法和无创指或鼻片法进行ICG消除试验以及包括血清和尿液β2在内的肾功能检测。 - 微球蛋白（BMG）、钠排泄分数（FENa）、24小时肌酐清除率值（CCr）、血清肌酐值（Cr）、同时测定N-乙酰基-β-D-氨基葡萄糖苷酶(NAG)值。结果：POD 10前CI显着高于LDLT前(4.303A1.294 vs 3.165±0.999 1/min/m^2: P< . 05) … 更多 . POD 14 后，LDLT 前和标准化之间的 CI 没有显着差异（POD 14： 3.136±1.092，CI正常范围3-4 1/min/m^2)至于肾功能检查，在术前第14天比较各因素时，CCr从75.9±34.2(ml/min)下降至46.1±。 19.6. NAG显示17.6±12.1(U/为14.0±11.6，表示近端至于尿BMG显示729.9±2012.5（μg/I）至939.21±431.3，则表示肾小管和肾小球的FENa显示1.2±1.1（%）至1.0±0.7，不显示肾小管和肾小球疾病。 Cr 显示 1.2±1.1 (mg/dl) 至 0.7±0.3，如结论：ESLD患者的血流动力学特征是心输出量极大，即所谓的高动力状态，在本研究中，CI在POD 10之前明显高于LDLT之前，因此，我们认为高动力阶段持续。 LDLT 后至少 10 天。尽管 LDLT 后 Cr 值有所改善，但仍存在明显的肾脏疾病，例如 NAG 和 BMG 值升高，尽管 ICG 测试被认为是对循环变化非常有用的评估方法。 ESLD患者围术期管理中，循环变化的改善并不一定意味着肾功能的改善，因此，在考虑LDLT患者的肾功能时，应少考虑循环变化以外的因素。

项目成果

Long-term outcomes of 600 living donor liver transplants for pediatric patients at a single center

• DOI: 10.1002/lt.20826
• 发表时间: 2006-09-01
• 期刊: LIVER TRANSPLANTATION
• 影响因子: 4.6
• 作者: Ueda, Mikiko;Oike, Fumitaka;Tanaka, Koichi
• 通讯作者: Tanaka, Koichi

生体肝移植におけるエンドトキシン吸着療法(PMX-DHP)の効果

内毒素吸附疗法（PMX-DHP）在活体肝移植中的效果

• 发表时间: 2006
• 期刊: Therapeutic Research 2006 12
• 作者: 小崎浩一;石崎守彦 他
• 通讯作者: 石崎守彦 他

Successful Treatment of Invasive Pulmonary Aspergillosis After ABO-Incompatible Living Donor Liver Transplantation Under Rapid Steroid Withdrawal Protocol

在快速类固醇撤药方案下成功治疗 ABO 不相容活体肝移植后的侵袭性肺曲霉病

• 发表时间: 2007
• 期刊: Transplantation 83
• 作者: Yoshimoto T;Yazumi S;Chiba T;et. al.;八隅 秀二郎;Shujiro Yazumi;八隅 秀二郎;八隅 秀二郎;Shujiro Yazumi;八隅 秀二郎;Shujiro Yazumi;貝原 聡
• 通讯作者: 貝原 聡

Hepatic Artery Aneurysm after ABO Type Incompatibility Living Donor Liver Transplantation

ABO 血型不合活体肝移植后肝动脉瘤

• 发表时间: 2007
• 作者: Hidetaka;UShigome;Kazuki;Sakai;Tomoyuki;Suzuki;Syuji;Nobori;Atsushi;Yoshizawa;Satoshi;Kaihara;Masahiko;Okamoto;Norio;Yoshimura
• 通讯作者: Yoshimura

生体肝移植における深在性真菌感染症対策

活体肝移植中深部真菌感染的防治措施

• 发表时间: 2007
• 作者: 小崎浩一;石崎守彦 他;貝原 聡;牛込 秀隆;昇 修治;貝原 聡
• 通讯作者: 貝原 聡