Effect of mesocaval shunt on survival of small-for-size liver grafts: experimental study in pigs.
Segmental liver grafts with a calculated ideal liver weight (CILW) less than 40% may be associated with portal flow-related injuries and primary dysfunction. This study evaluated the effect of mesocaval shunts on the survival of grafts with a CILW less than 20%. Sixteen pigs underwent orthotopic transplantation of segmental liver grafts with a CILW less than 20%. In eight animals (study group), transplantation was combined with a mesocaval shunt, and eight animals served as controls without a mesocaval shunt. Liver function, systemic hemodynamics, portal vein pressure, intracranial pressure, and cerebral perfusion pressure were assessed postoperatively. The controls showed a rapid impairment of liver function reflected by a significant elevation in aspartate aminotransferase, international normalized ratio, bilirubin, and intracranial pressure and a decrease in cerebral perfusion pressure compared with the study group (P<0.05). Mesocaval shunts showed protective effects on grafts with CILW less than 20% and may have a clinical role in the salvage of small-for-size liver grafts.
Smyrniotis
Vassilios E
VE
Second Department of Surgery, University of Athens Medical School, Aretaieion Hospital, Athens, Greece.
Kostopanagiotou
Georgia
G
Theodoraki
Kassiani
K
Gamaletsos
Evangelos
E
Kondi-Pafiti
Agathi
A
Mystakidou
Kyriaki
K
Arkadopoulos
Nikolaos
N
D000818:Animals; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001794:Blood Pressure; D002560:Cerebrovascular Circulation; D006085:Graft Survival; D006439:Hemodynamics; D007427:Intracranial Pressure; D008099:Liver / Q000033:anatomy & histology* / Q000473:pathology / Q000503:physiopathology; D008107:Liver Diseases / Q000209:etiology; D016031:Liver Transplantation / Q000009:adverse effects; D009929:Organ Size; D011170:Portasystemic Shunt, Surgical; D011184:Postoperative Period; D013552:Swine
D001219:Aspartate Aminotransferases; D001663:Bilirubin