| Liver transplantation has been a major and effective method for treating varies of end-stage liver disease. With the developing of surgical technique and perioperative management,there are a lot of patients on the transplantation list and waiting for operation. But the donors of human liver are very scare especially in the countries or regions where the concept of "brain death" has not been acceped.On the other hand,many mild damaged donors, such as hepatic steatosis, have been discarded because of relative high rate of primary non-function (PNF) after operation.But the mechanism of PNF and the effect of steatosis on reduced-size liver transplantation has not been elucidated.In the rat steatotic model,we explore the effect of fatty liver on graft survival,especially with reference to macrovesicular and microvesicular steatosis and assess the relationship between histological grade,inflammation activity using numerical scoring system and the postoperative survival rate in different groups;we also explore liver regeneration and effective protective methods for liver transplantation in fatty donors.It would give birth to new ideas for further experimental study and intervention for clinical treatments.Firstly, different degrees of rat fatty liver model were established by feeding rats a diet consisting of 79% standard diet,20% lard and 1% cholesterol.We found: (1) With this method for 4 weeks,6 weeks and 8 weeks,hepatic steatosis of grade I , II ,III and macrovescicular with different grade of inflammation and necrosis had been found;(2)The microvescicularchange has been showed when past 10 weeks in this model;(3)The ability ofanti-oxidative is damaged and lipid peroxide such as MDA is increased;(4) The liver function damaged only in the severe steatosis.Our results indicated that this method of model is similar to human natural hepatic steatosis and the death of animal is lower.Secondly,By modified two cuff vascular anastomoses and end to end suture for bile duct,rat orthotopic liver transplantation were performed in an attempt to assess the relationship between donor histological classification and survival rate. We found: (1)The survival rate of macrosteatosis (grade III) is poor, most rats died of liver failure in early days after transplantation, pathological findings were showed frequently hepatic necrosis.(2)There is no significantly difference between macrosteatosia(grade I ) and the normal group,after transplantation almost all of the fat is cleared by the end of the fourth week; (3) Diminished steatosis and liver regeneration were foud hi macrosteatosis (grade II ),while microsteatotic donors have higher survival rate than the other groups except the normal ones.Thirdly, By modified two cuff vascular anastomoses and end to end suture for bile duct, rat different reduced-size orthotopic liver transplantation were performed in an attempt to explore the recipient body weight, graft weight, recipient original liver weight, histological and electron-microscopic findings in comparison with whole rat liver transplantation.We found: (1)One week survival rate of the whole liver transplantation, 70% reduced-size liver transplantation(ROLT), 60%ROLT and 50%ROLT group (grade I steatotic donor) was 91.67%, 75%, 75%, 25%; 2 week survival rate was 83.33%, 75%, 58.33%, 0; and their ratios of graft weight and recipient body weight was 3.56 @ 0.36%, 2.53@0.15%, 2.28@0.12%, 1.83@0.16% respectively. (2)In grade II steatotic donor, one week survival rate of the whole liver transplantation and 70% ROLT was 83.33%, 25%. (3)Donor livers with microvescicular fat undergoing whole liver transplantation and 70% ROLT,60%ROLT,50%ROLT, the one week survival rate was 83.33%, 75%, 75%, 33.33%; 2 week survival rate was 75%, 66.67%, 66.67%, 0. (4)The survival rate of 50%ROLT in grade I steatotic donor and livers mainly with microvescicular fat were significantly different with other groups. While steatotic donors in grade II ,the 1 week survival rate of 70% ROLT was very poor.Fourthly, With the model of...
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