[Preliminary experimental study on treatment of portal hypertension with auxiliary partial orthotopic liver transplantation].
OBJECTIVE
To evaluate the therapeutic efficacy of auxiliary partial orthotopic liver transplantation (APOLT) on portal hypertension in liver cirrhosis with amelioration of portal vein congestion, changes in portal vein pressure and status of the graft.


METHODS
The recipients were porcine model of biliary cirrhosis reproduced by ligation of the common bile duct. During transplantation, arterial blood pressure, central venous pressure were recorded. Buffer base, standard bicarbonate and pH of arterial blood samples were determined and analyzed in order to assess the impact of operation on the animals. The hemodynamics were also monitored. Color Doppler ultrasonographic examination was performed on recipients before operation, intra-operation and 7 days after operation, respectively. Portal vein pressure, blood bilirubin and variables of liver function were measured by using an autoanalyzer. Wedge biopsy specimens of each pig were obtained, stained with hematoxylin-eosin, and examined. Analysis of variance was performed. Otherwise non-parametric tests were used.


RESULTS
Eight weeks after ligation of the common bile duct, biliary cirrhosis was reproduced in all the pigs, and histopathological examination of the liver specimen showed a large number of pseudo-lobules. In 6 pigs with hepatic cirrhosis liver transplantation was done. Five of the 6 (83.3%) animals survived for 7 days. One recipient died because of unsuccessful operation, the others showed stable hemodynamics during the operation. Seven days after transplantation, the blood flow of the two liver portal veins was observed by the use of color Doppler ultrasonography. It was found that the blood flow in the donor portal vein was much richer than that of native portal vein. The venous outflow of the graft was ample and smooth, and no thrombosis of the hepatic vein or portal vein was found. The variables, including alanine aminotransferase, aspartate aminotransferase, bilirubin and total bilirubin, were significantly improved 7 days after operation compared with pre-operative data. Portal pressure was found to be (20.76+/-2.42)cm H(2)O(1 cm H(2)O=0.098 kPa), (17.62+/-2.33)cm H(2)O and (14.72+/-2.25)cm H(2)O before the operation, during the operation, and 7 days after operation, respectively, and the difference was statistically significant(P<0.01). On the 7 days after transplantation, histopathological examination revealed evidence of damage with mild steatosis and sporadic necrotic hepatocytes and focal hepatic lobular degeneration in the graft, especially in the area around the central vein.


CONCLUSIONS
APOLT is a hopeful option for the treatment of portal hypertension. This procedure can provide not only some improvement of the liver function but also decrease the pressure of portal vein.
Shi
Liu-bin
LB
Department of organ transplantation, Huashan Hospital, Fudan University, Shanghai 200040, China.
Peng
Cheng-hong
CH
Peng
Shu-you
SY
Liu
Ying-bin
YB
He
Wei
W
Xu
Bin
B
Chen
Xiao-peng
XP
Bai
Ming-dong
MD
Wang
Yong
Y
Tang
Ze
Z
D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D013552:Swine; D016896:Treatment Outcome