title: Portomesenteric disconnection for small-for-size grafts in liver transplantation: Preclinical studies in pigs.
abstract: This study reviews the evaluation and results of a new liver transplantation technique for small-for-size grafts with portomesenteric disconnection. Twenty Large-White pigs underwent heterotopic liver transplantation after a mesocaval shunt, ligation of the superior mesenteric vein downstream from the shunt, and ligation of the recipient portal vein near the native liver. The donor-to-recipient weight ratio was 24%, and the graft-to-recipient weight ratio was 0.6%. In five control pigs, no mesocaval shunt was performed. The mesocaval shunt provided diversion of 60% of the splanchnic blood flow. The median survival of study pigs was 39 days (range, 8 to 98). Median serum bilirubin levels at 1 week were 12 micromol/L (range, 4 to 59). At autopsy, graft weight was increased to 2.7 times the initial weight and histologic findings were normal. In the control group, all pigs died quickly of acute splanchnic congestion. Portomesenteric disconnection was effective to achieve survival of small-for-size grafts in pig liver transplantation.
authors.affiliation: Unité de Transplantation Hépatique, Hôpital Edouard-Herriot, Lyon, France. boillot@cismsun.univ-lyon1.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Boillot
authors.forename: Isabelle
authors.initials: I
authors.lastname: Mechet
authors.forename: Yannick
authors.initials: Y
authors.lastname: Le Derf
authors.forename: Pierre
authors.initials: P
authors.lastname: Bernard
authors.forename: Paolo
authors.initials: P
authors.lastname: Figueiredo
authors.forename: Françoise
authors.initials: F
authors.lastname: Berger
authors.forename: Christian
authors.initials: C
authors.lastname: Paquet
authors.forename: Michel
authors.initials: M
authors.lastname: Pouyet
mesh_terms: D000818:Animals; D001824:Body Constitution; D008099:Liver / Q000473:pathology / Q000601:surgery; D008102:Liver Circulation; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008642:Mesenteric Veins / Q000601:surgery*; D011169:Portal Vein / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical; D013152:Splanchnic Circulation; D034421:Sus scrofa