title: 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.
abstract: 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.
authors.affiliation: Department of Visceral and Vascular Surgery, University of Cologne, Cologne, Germany. karina.schleimer@medizin.uni-koeln.de
authors.forename: Karina
authors.initials: K
authors.lastname: Schleimer
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Stippel
authors.forename: Hans-Udo
authors.initials: HU
authors.lastname: Kasper
authors.forename: Samir
authors.initials: S
authors.lastname: Tawadros
authors.forename: Christian
authors.initials: C
authors.lastname: Suer
authors.forename: Klaus
authors.initials: K
authors.lastname: Schomäcker
authors.forename: Arnulf
authors.initials: A
authors.lastname: Hölscher
authors.forename: K Tobias E
authors.initials: KT
authors.lastname: Beckurts
mesh_terms: 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
chemical_list: D019408:Platelet Endothelial Cell Adhesion Molecule-1; D019275:Radiopharmaceuticals; D019784:Technetium Tc 99m Diethyl-iminodiacetic Acid