title: Porcine partial liver transplantation without veno-venous bypass: an effective model for small-for-size liver graft injury.
abstract: OBJECTIVE
  Partial liver transplantation is currently gaining wider acceptance, which alleviates donor organ shortage, but also reveals the problem of small-for-size (SFS) syndrome. The precise mechanism behind it remains unknown. Large animal models for SFS syndrome are being developed using veno-venous bypass (VVB), however, splenectomies have often become necessary making the models useless for clinical situations. This study establishes a clinically well-simulated and effective model of SFS graft injury without VVB.
  
  
  METHODS
  In this study, 30% and 100% of liver grafts were orthotopically transplanted to pigs in groups A (n = 12) and B (n = 5), respectively, both without VVB. Intraoperative hemodynamics and metabolic parameters were assessed consecutively. The operative survival rates were evaluated during 7 days of follow-up as well as the serum biochemical profiles, the kinesis of portal pressure gradient, and the pathological findings.
  
  
  RESULTS
  All the recipients survived the anhepatic period except one in group A who died of irretrievable acidosis. The tolerance rate for non-VVB were 91.7% (11/12) in group A and 100% (5/5) in group B with no significant differences. The 7-day survival rate in group A was significantly less than that for group B (50% versus 100%, P < .05) with more prolonged prothrombin times, increased bilirubin and alanine aminotransferase levels, and persistantly higher values of portal pressure gradient during almost the entire follow-up period. Accordingly, the pathological findings clarified more severe microvascular impairments in group A than group B.
  
  
  CONCLUSIONS
  These data suggest that the model of pigs transplanting with 30% liver grafts without VVB is safe and reproducible. The good clinical simulation on operative procedures and clinicopathological performance indicates it is a more rational model for further research on SFS syndrome.
authors.affiliation: 5th Department of Liver Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Fu
authors.forename: H-B
authors.initials: HB
authors.lastname: Zhang
authors.forename: N
authors.initials: N
authors.lastname: Yang
authors.forename: N
authors.initials: N
authors.lastname: Zhu
authors.forename: H
authors.initials: H
authors.lastname: Si-Ma
authors.forename: W
authors.initials: W
authors.lastname: Chen
authors.forename: W-C
authors.initials: WC
authors.lastname: Zhao
authors.forename: G-S
authors.initials: GS
authors.lastname: Yang
mesh_terms: D000818:Animals; D005260:Female; D006439:Hemodynamics; D007677:Kidney Function Tests; D008111:Liver Function Tests; D016031:Liver Transplantation; D008954:Models, Biological; D013552:Swine; D013556:Swine, Miniature; D014656:Vascular Surgical Procedures