RESUMEN
OBJECTIVE: Partial liver transplantation is currently gaining wider acceptance, which alleviates donor organ shortage, but also reveals the problem of small-for-size (SFS) syndrome. The precise mechanism behind it remains unknown. Large animal models for SFS syndrome are being developed using veno-venous bypass (VVB), however, splenectomies have often become necessary making the models useless for clinical situations. This study establishes a clinically well-simulated and effective model of SFS graft injury without VVB. METHODS: In this study, 30% and 100% of liver grafts were orthotopically transplanted to pigs in groups A (n = 12) and B (n = 5), respectively, both without VVB. Intraoperative hemodynamics and metabolic parameters were assessed consecutively. The operative survival rates were evaluated during 7 days of follow-up as well as the serum biochemical profiles, the kinesis of portal pressure gradient, and the pathological findings. RESULTS: All the recipients survived the anhepatic period except one in group A who died of irretrievable acidosis. The tolerance rate for non-VVB were 91.7% (11/12) in group A and 100% (5/5) in group B with no significant differences. The 7-day survival rate in group A was significantly less than that for group B (50% versus 100%, P < .05) with more prolonged prothrombin times, increased bilirubin and alanine aminotransferase levels, and persistantly higher values of portal pressure gradient during almost the entire follow-up period. Accordingly, the pathological findings clarified more severe microvascular impairments in group A than group B. CONCLUSION: These data suggest that the model of pigs transplanting with 30% liver grafts without VVB is safe and reproducible. The good clinical simulation on operative procedures and clinicopathological performance indicates it is a more rational model for further research on SFS syndrome.
Asunto(s)
Trasplante de Hígado , Modelos Biológicos , Procedimientos Quirúrgicos Vasculares , Animales , Femenino , Hemodinámica , Pruebas de Función Renal , Pruebas de Función Hepática , Porcinos , Porcinos EnanosRESUMEN
OBJECTIVE: To explore the surgical techniques of hepatic artery reconstruction in liver transplantation (OLT) and the choice of treatment for hepatic artery thrombosis (HAT). METHODS: We analyzed hepatic artery reconstructions based on 234 cadaveric donor liver transplantations and seven living related liver transplantations from April 2003 to February 2009. Anastomosis time was compared between the groups with respect to vascular caliber. Interventional thrombolysis or early thrombectomy and hepatic artery reconstruction was implemented in three HAT cases. RESULTS: The hepatic artery anastomoses for vessels less than 3 mm in diameter (n = 78) required 33.6 ± 21.3 minutes which were significantly greater compared with those for vessels more than 3 mm in diameter (n = 163; 19.4 ± 7.4 minutes). Among two patients (0.83%) who developed early HAT within the first week after the operation, one was successfully treated by interventional thrombolysis, but the other required an urgent conduit between the aorta and the graft after attempted thrombolysis. Only one patient (0.41%) displayed a delayed HAT without special management, but recovered liver function upon follow-up. DISCUSSION: Early detection and proper revascularization measures can yield satisfactory results after HAT.