Liver regeneration in rats after liver resection and small for size liver transplantation from living donors [Elektronische Ressource] / vorgelegt von Qing He

He Qing

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• Publié par: universitat_duisburg-essen
• Publié le: 01 janvier 2004
• Nombre de lectures: 35
• Langue: English

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Liver Regeneration in Rats
after Liver Resection and Small-for-size
Liver Transplantation from Living Donors












Qing He
Medizinische Fakultät
der
Universität Duisburg-Essen

Zentrum für Chirurgie
Aus der Klinikum für Allgemein- und Transplantationschirugie


Liver Regeneration in Rats after Liver Resection and
Small-for-size Liver Transplantation from Living Donors



Inaugural-Dissertation
Zur
Erlangung des Doktorgrades der Medizin
durch die Medizinische Fakultät
der Universität Duisburg-Essen




Vorgelegt von
Qing He
aus Guangzhou, China
2004
Medical Faculty of University Duisburg-Essen
Department of General and Transplantation Surgery



Liver Regeneration in Rats after Liver Resection and
Small-for-size Liver Transplantation from Living Donors




Inaugural -Dissertation
for Application of Doctor's Degree of Medicine
in the Medical Faculty
of University Duisburg-Essen



Presented by
Qing He
From Guangzhou, China
2004


















Dekan: Univ. -Prof. Dr. H. Grosse-Wilde
1. Gutachter: Priv. -Doz. Dr. med. Uta Dahmen
2. Gutachter: Univ. -Prof. Dr. mde. Guido Gerken

thDate of examination: 29 , July, 2004. CONTENTS
1 INTRODUCTION ........................................................................................................... 5
1.1 Living donor liver transplantation using small-for-size grafts.... 5
1.2 Liver regeneration after hepatectomy and partial liver transplantation .................... 6
1.2.1 Basic characteristics of liver regeneration ............................................................. 6
1.2.2 Factors influencing liver regeneration.................................... 7
1.2.3 Immunological regulation of liver regeneration ...................................................... 8
1.2.3.1 Influence of immune activation...................................................................... 8
1.2.3.2 Effect of inhibiting immune activation............................ 8
1.3 Methods for assessing liver regeneration ................................................................. 9
1.4 Aim of this study ...................................... 11
2 MATERIALS AND METHODS.................................................................................... 12
2.1 Experimental design ................................................................................................ 12
2.1.1 Control groups...... 12
2.1.2 Experimental groups............................................................................................. 12
2.2 Animals .................................................... 14
2.3 Operations............................................................................... 16
2.3.1 Partial hepatectomy.............................................................................................. 16
2.3.2 Nonarterialized small-for-size orthotopic liver transplantation............................. 16
2.4 Treatment................................................................................................................. 16
2.4.1 Standard perioperative treatment......... 16
2.4.2 Glucose supplementation..................................................................................... 16
1
2.4.3 Vaccination ........................................................................................................... 16
2.4.4 Immunosuppressive treatment............. 16
2.5 Sampling of animals ................................................................................................ 17
2.6 Evaluation of liver regeneration ............................................................................... 17
2.6.1 Immunohistochemical staining of BrdU ................................................................ 17
2.6.2 Analysis of BrdU LI............................................................... 20
2.7 Validation of quantification method and immunohistochemical assay................... 20
2.7.1 Comparison of methods to quantify unlabeled hepatocyte nuclei ....................... 20
2.7.1.1 Correlation between conventional and computer-assisted counting.......... 20
2.7.1.2 Intra-observer reproducibility in computer-..................... 20
2.7.1.3 Inter-observer reproducibility in computer-assisted counting 22
2.7.2 Assay precision of BrdU-IHC staining .................................................................. 22
2.7.2.1 Quality criteria of BrdU-IHC staining........................... 22
2.7.2.2 Intra-assay variation of BrdU-IHC staining.................................................. 23
2.7.2.3 Inter-- 23
2.8 Statistical analysis ................................................................................................... 23
3 RESULTS .................................................................................................................... 24
3.1 Validation of quantification method and immunohistochemical assay................... 24
3.1.1 Comparison of methods to quantify unlabeled hepatocyte nuclei ....................... 24
3.1.2 Assay precision of BrdU-IHC staining .................................................................. 26
3.2 Kinetics of regeneration after small-for-size liver transplantation ........................... 27
3.3 Influence of extended cold ischemia on regeneration of a small-for-size graft...... 31
3.4 Immunological regulation of liver regeneration ....................................................... 34
2
3.4.1 Immune activation by vaccination on liver regeneration ...................................... 34
3.4.2 Effect of inhibiting immune activation by immunosuppressive drugs on liver
regeneration.......................................................................................................... 37
4 DISCUSSION............... 40
4.1 Validation of quantification method and immunohistochemical assay................... 40
4.1.1 Correlation between conventional and computer-assisted counting 40
4.1.2 Assay precision of BrdU-IHC staining .................................................................. 41
4.2 Kinetics of regeneration after small-for-size liver regeneration .............................. 42
4.2.1 Delayed onset of regeneration after transplantation ............................................ 42
4.2.2 Possible explanations for the delayed onset of regeneration.............................. 44
4.3 Influence of extended cold ischemia on regeneration of a small-for-size graft...... 45
4.3.1 Extended Ischemia reducing liver regeneration................................................... 45
4.3.2 Speculation regarding the mechanism................................................................. 46
4.4 Immunological regulation of liver regeneration ....................................................... 47
4.4.1 Feedback mechanism between liver regeneration and immune activation......... 48
4.4.1.1 Experimental evidence supporting the hypothesis ..................................... 48
4.4.1.2 Animal model and experimental design ...................................................... 48
4.4.1.3 Possible mechanism of the inhibitory effort of immune activation on liver
regeneration................................................................................................. 49
4.4.2 Enhancement of the regenerative response by inhibition of immune activation. 50
4.4.2.1 Experimental evidence supporting the hypothesis ..................................... 50
4.4.2.2 Animal model and experimental design ...................................................... 52
4.4.2.3 Inhibition of immune activation and liver regeneration................................ 53
4.4.2.3.1 Inhibition of immune activation by calcineurin inhibitors........................ 53
4.4.2.3.2 Inhibition of immune activation by antiproliferative drugs ...................... 53
3
5 SUMMARY .................................................................................................................. 56
6 REFERENCE LIST...................................................................................................... 57
7 ABBREVIATIONS....... 69
8 ACKNOWLEDGMENT ................................................................................................ 71
9 PUBLICATIONS.......................................................................................................... 72
10 CURRICULUM VITAE ................................................................................................. 74































4
1 INTRODUCTION
1.1 Living donor liver transplantation using small-for-size grafts
Living donor liver transplantation (LDLT), using a relative or another person closely
related to the recipient as a donor, was theoretically p