Excessive portal flow causes graft failure in extremely small-for-size liver transplantation in pigs.
OBJECTIVE
To evaluate the effects of a portocaval shunt on the decrease of excessive portal flow for the prevention of sinusoidal microcirculatory injury in extremely small-for-size liver transplantation in pigs.


METHODS
The right lateral lobe of pigs, i.e. the 25% of the liver, was transplanted orthotopically. The pigs were divided into two groups: graft without portocaval shunt (n = 11) and graft with portocaval shunt (n = 11). Survival rate, portal flow, hepatic arterial flow, and histological findings were investigated.


RESULTS
In the group without portocaval shunt, all pigs except one died of liver dysfunction within 24 h after transplantation. In the group with portocaval shunt, eight pigs survived for more than 4 d. The portal flow volumes before and after transplantation in the group without portocaval shunt were 118.2+/-26.9 mL/min/100 g liver tissue and 270.5+/-72.9 mL/min/100 g liver tissue, respectively. On the other hand, in the group with portocaval shunt, those volumes were 124.2+/-27.8 mL/min/100 g liver tissue and 42.7+/-32.3 mL/min/100 g liver tissue, respectively (P<0.01). As for histological findings in the group without portocaval shunt, destruction of the sinusoidal lining and bleeding in the peri-portal areas were observed after reperfusion, but these findings were not recognized in the group with portocaval shunt.


CONCLUSIONS
These results suggest that excessive portal flow is attributed to post transplant liver dysfunction after extreme small-for-size liver transplantation caused by sinusoidal microcirculatory injury.
Wang
Hong-Sheng
HS
Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
Ohkohchi
Nobuhiro
N
Enomoto
Yoshitaka
Y
Usuda
Masahiro
M
Miyagi
Shigehito
S
Asakura
Takeshi
T
Masuoka
Hiroo
H
Aiso
Takashi
T
Fukushima
Keisuke
K
Narita
Tomohiro
T
Yamaya
Hideyuki
H
Nakamura
Atsushi
A
Sekiguchi
Satoshi
S
Kawagishi
Naoki
N
Sato
Akira
A
Satomi
Susumu
S
D000818:Animals; D006085:Graft Survival; D006439:Hemodynamics; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000378:metabolism / Q000473:pathology / Q000648:ultrastructure; D008115:Liver Regeneration; D016031:Liver Transplantation; D008833:Microcirculation / Q000473:pathology*; D011167:Portacaval Shunt, Surgical; D012039:Regional Blood Flow; D015996:Survival Rate; D013552:Swine