title: Auxiliary partial orthotopic liver transplantation from living donors: significance of portal blood flow.
abstract: BACKGROUND
  Auxiliary liver transplantation has several advantages over standard orthotopic liver transplantation. However, functional competition has been reported even in auxiliary partial orthotopic liver transplantation (APOLT). We evaluated herein the interaction in APOLT between the native liver and the graft in terms of portal blood flow and regeneration. The need for diversion of the portal blood flow to the graft was also assessed.
  
  
  METHODS
  A total of 15 patients received APOLT from living donors. Portal blood flow to the native liver was preserved in 6 patients, and the portal vein to the native liver was preemptively transected at the time of transplantation in 9 patients.
  
  
  RESULTS
  Of the patients with preservation of the portal blood flow to the native liver, two showed inadequate graft portal blood flow just after operation, and in the other three patients the graft portal blood flow decreased or the graft atrophied after deterioration of the graft function. In the patients with preemptive transection of the portal vein to the native liver, optimal graft portal blood flow was obtained, and the native liver, supplied only by arterial inflow, supported a small-for-size graft until the graft regenerated. The damage to the native liver was minimal.
  
  
  CONCLUSIONS
  Functional competition may occur in APOLT with preservation of the portal blood flow to the native liver, whereas preemptive transection of the native liver portal vein is a safe procedure and effectively prevents the portal steal phenomenon.
authors.affiliation: Department of Gastroenterological Surgery, Kyoto University Graduate School of Medicine, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Yabe
authors.forename: H
authors.initials: H
authors.lastname: Egawa
authors.forename: Y
authors.initials: Y
authors.lastname: Inomata
authors.forename: S
authors.initials: S
authors.lastname: Uemoto
authors.forename: K
authors.initials: K
authors.lastname: Asonuma
authors.forename: T
authors.initials: T
authors.lastname: Kiuchi
authors.forename: H
authors.initials: H
authors.lastname: Nishizawa
authors.forename: A M
authors.initials: AM
authors.lastname: Shapiro
authors.forename: Y
authors.initials: Y
authors.lastname: Yamaoka
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged