title: Porcine partial liver transplantation: a novel model of the "small-for-size" liver graft.
abstract: Increasing shortage of cadaveric grafts demands the utilization of living donor and split liver grafts. The purpose of this study was to 1) define the "small-for-size" graft in a pig liver transplant model 2) evaluate pathological changes associated with small-for-size liver transplantation. Pigs were divided into four groups based on the volume of transplanted liver: (a) control group (n=4), 100% liver volume (LV) (b) group I (n=8), 60% LV (c) group II (n=8), 30% LV (d) group III (n=15), 20% LV. Tacrolimus and methyl prednisone were administered as immunosuppression. Animals were followed for 5 days with daily serum biochemistry, liver biopsies on day 3 and 5 for light microscopy, and tissue levels of thymidine kinase (TK) and ornithine decarboxylase (ODC). Liver grafts were weighed pretransplant and at sacrifice. All the recipients of 100%, 60%, and 30% grafts survived. Transplantation of 20% grafts (group III) resulted in a 47% mortality rate. Group III animals showed significantly prolonged prothrombin times (p<0.05), elevated bilirubin levels (p<0.05), and ascites. The rate of regeneration, as indicated by TK activity and graft weight was inversely proportional to the size of the transplanted graft. The severity of the microvascular injury was inversely proportional to graft size and appeared to be the survival-limiting injury. Frank rupture of the sinusoidal lining, parenchymal hemorrhage, and portal vein injury were prominent in group III animals 1 hour following reperfusion. This study established a reproducible large animal model of partial liver grafting; it defined the small-for-size syndrome in this model and described the associated microvascular injury.
authors.affiliation: Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. Kellydm@msx.upmc.edu
authors.forename: Dympna M
authors.initials: DM
authors.lastname: Kelly
authors.forename: A Jake
authors.initials: AJ
authors.lastname: Demetris
authors.forename: John J
authors.initials: JJ
authors.lastname: Fung
authors.forename: Amadeo
authors.initials: A
authors.lastname: Marcos
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhu
authors.forename: Vladimir
authors.initials: V
authors.lastname: Subbotin
authors.forename: Lu
authors.initials: L
authors.lastname: Yin
authors.forename: Eishi
authors.initials: E
authors.lastname: Totsuka
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Ishii
authors.forename: Ming C
authors.initials: MC
authors.lastname: Lee
authors.forename: Jorge
authors.initials: J
authors.lastname: Gutierrez
authors.forename: Guilherme
authors.initials: G
authors.lastname: Costa
authors.forename: Raman
authors.initials: R
authors.lastname: Venkataraman
authors.forename: Juan R
authors.initials: JR
authors.lastname: Madariaga
mesh_terms: D000818:Animals; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D005260:Female; D006085:Graft Survival; D007166:Immunosuppressive Agents / Q000097:blood; D019344:Lactic Acid / Q000097:blood; D008099:Liver / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D008115:Liver Regeneration; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011184:Postoperative Period; D015203:Reproducibility of Results; D013552:Swine; D016559:Tacrolimus / Q000097:blood; D014652:Vascular Diseases / Q000209:etiology
chemical_list: D007166:Immunosuppressive Agents; D019344:Lactic Acid; D001219:Aspartate Aminotransferases; D001663:Bilirubin; D016559:Tacrolimus