title: Extension of the indication for living related liver transplantation from children to adults based on resolution of graft size mismatch in relation to tissue oxygenation and metabolic load: a case report.
abstract: We extended the indication for living related partial liver transplantation from pediatric to adult cases. Our first case was a 49-year-old woman with primary biliary cirrhosis. Her sister's left lobe, weighing 280 g, was employed as a graft, and the graft weight/recipient's body weight ratio was calculated as 0.59%. To decrease the metabolic load to the relatively small graft, the total bilirubin was decreased from a maximum value of 75.0 mg/d1 to the most recent preoperative value of 36.2 mg/dl by plasma exchange. Intraoperative recovery of tissue oxygenation and its heterogeneity were satisfactory due to a relatively high blood supply. A postoperative decrease in bilirubin and increase in cholesterol esterification were facilitated, concomitant with regeneration of the graft, which weighed 280 g, to 860 cm3 at 3 weeks. Linear regression analysis with respect to tissue oxygenation and metabolic capacity obtained in pediatric cases were applied to this adult case.
authors.affiliation: Second Department of Surgery, Faculty of Medicine, Kyoto University, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Tanaka
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
authors.forename: H
authors.initials: H
authors.lastname: Shinohara
authors.forename: E
authors.initials: E
authors.lastname: Hatano
authors.forename: S
authors.initials: S
authors.lastname: Sato
authors.forename: A
authors.initials: A
authors.lastname: Kanazawa
authors.forename: T
authors.initials: T
authors.lastname: Kitai
authors.forename: H
authors.initials: H
authors.lastname: Higashiyama
authors.forename: Y
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Y
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: H
authors.initials: H
authors.lastname: Okajima
authors.forename: H
authors.initials: H
authors.lastname: Egawa
authors.forename: I
authors.initials: I
authors.lastname: Ikai
authors.forename: S
authors.initials: S
authors.lastname: Uemoto
authors.forename: I
authors.initials: I
authors.lastname: Satomura
authors.forename: N
authors.initials: N
authors.lastname: Ozaki
authors.forename: Y
authors.initials: Y
authors.lastname: Inomata
authors.forename: Y
authors.initials: Y
authors.lastname: Yamaoka
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D008099:Liver / Q000378:metabolism*; D016031:Liver Transplantation; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism*
chemical_list: D010100:Oxygen