title: Excessive portal flow causes graft failure in extremely small-for-size liver transplantation in pigs.
abstract: 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.
authors.affiliation: Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
authors.forename: Hong-Sheng
authors.initials: HS
authors.lastname: Wang
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ohkohchi
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Enomoto
authors.forename: Masahiro
authors.initials: M
authors.lastname: Usuda
authors.forename: Shigehito
authors.initials: S
authors.lastname: Miyagi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Asakura
authors.forename: Hiroo
authors.initials: H
authors.lastname: Masuoka
authors.forename: Takashi
authors.initials: T
authors.lastname: Aiso
authors.forename: Keisuke
authors.initials: K
authors.lastname: Fukushima
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Narita
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Yamaya
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakamura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sekiguchi
authors.forename: Naoki
authors.initials: N
authors.lastname: Kawagishi
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.forename: Susumu
authors.initials: S
authors.lastname: Satomi
mesh_terms: 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