Auxiliary liver transplantation with flow-regulated portal vein arterialization offers a successful therapeutic option in acute hepatic failure--investigations in heterotopic auxiliary rat liver transplantation.
Heterotopic auxiliary liver transplantation (HALT) with portal vein arterialization (PVA) was proposed in acute hepatic failure (AHF). However, clinical results of PVA are controversial because of lacking standardized flow-regulation. In rats, we examined HALT with flow-regulated PVA in AHF. Group A: HALT with flow-regulated PVA and 85% resection of the native liver to induce AHF [acute experiments (n = 8), killing after 7 days (n = 8) and after 6 weeks (n = 11)]. Group B: 85% liver-resection (n = 10). The average blood-flow in the arterialized portal vein in HALT achieved normal values (1.7 +/- 0.4 ml/min/g liver-weight). After reperfusion, the diameters of the sinusoids (6.4 +/- 0.6 microm), the postsinusoidal venules (31.1 +/- 3.3 microm) and the intersinusoidal distance (17.9+/-0.7 microm) also achieved normal values. The functional sinusoidal density amounted to 335 +/- 48/cm. The 6-week survival was nine of 11 with excellent liver function (Quick's value: 110% +/- 7.8%). The hepatobiliary radioisotope scanning with (99mTc) ethyl hepatic iminodiacetic acid (EHIDA) showed no significant differences between the native livers and grafts. The hepatocellular morphology was regular, apart from low-grade necroses in two grafts. The grafts' sinusoidal endothelial cells did not show any morphological changes. In group B, however, all rats died from AHF within 6 days. HALT with flow-regulated PVA achieved good results regarding microcirculation, morphology and function and can reliably bridge AHF.
Schleimer
Karina
K
Department of Visceral and Vascular Surgery, University of Cologne, Cologne, Germany. karina.schleimer@medizin.uni-koeln.de
Stippel
Dirk L
DL
Kasper
Hans-Udo
HU
Tawadros
Samir
S
Suer
Christian
C
Schomäcker
Klaus
K
Hölscher
Arnulf
A
Beckurts
K Tobias E
KT
D000818:Animals; D001652:Bile Ducts / Q000473:pathology; D001783:Blood Flow Velocity; D008099:Liver / Q000473:pathology / Q000601:surgery; D017114:Liver Failure, Acute / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D009929:Organ Size; D010477:Perfusion; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000096:biosynthesis; D011169:Portal Vein / Q000473:pathology; D019275:Radiopharmaceuticals / Q000494:pharmacology; D051381:Rats; D011917:Rats, Inbred Lew; D019784:Technetium Tc 99m Diethyl-iminodiacetic Acid / Q000494:pharmacology; D013997:Time Factors; D016042:Transplantation, Heterotopic
D019408:Platelet Endothelial Cell Adhesion Molecule-1; D019275:Radiopharmaceuticals; D019784:Technetium Tc 99m Diethyl-iminodiacetic Acid