Effect of portal haemodynamics on liver graft and intestinal mucosa after small-for-size liver transplantation in swine.
BACKGROUND
After small-for-size graft (SFSG) transplantation, elevated portal venous pressure (PVP) may lead to postoperative liver damage. Herein we evaluated the impact of portocaval shunt (PCS) to control PVP on liver grafts and intestine following SFSG transplantation.


METHODS
Nineteen SFSG transplantations were performed with 30% of native liver in swine. Swine were divided into 3 groups: a high-flow shunt group (HS: n = 7), in which portal venous flow (PVF) was reduced with a 10-mm diameter PCS; a low-flow shunt group (LS: n = 6), in which PVF was reduced with a 5-mm diameter PCS, and a no-shunt group (NS: n = 6), in which no PCS was placed.


RESULTS
Seven-day survivals were 83.3% in NS, 100% in LS and 0% in HS (p = 0.0088). PVP was significantly higher in the NS group (p = 0.0001; mean ± SEM NS/LS/HS: 20.5 ± 0.7/14.0 ± 1.2/11.6 ± 0.5 mm Hg). The LS group exhibited the highest compliance (PVF/PVP; NS/LS/HS 42.7 ± 10.9/44.6 ± 4.9/37.7 ± 8.3 ml/min/mm Hg; p = 0.009), the lowest aspartate aminotransferase (NS/LS/HS 562 ± 18/370 ± 55/720 ± 130 IU/l; p = 0.0493), and suppressed deleterious alternations of the hepatic parenchyma and intestinal mucosa.


CONCLUSIONS
Portal hypertension after SFSG transplantation impaired liver and intestinal mucosa; however, inadequate portal flow impaired not only the liver, but also survival.
Department of Hepatobiliary, Pancreas and Transplant Surgery, Kyoto University Graduate School of Medicine, Kyoto City, Japan. shintaro@kuhp.kyoto-u.ac.jp
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S
Yagi
T
T
Iida
T
T
Hori
K
K
Taniguchi
M
M
Nagahama
S
S
Isaji
S
S
Uemoto
D000818:Animals; D001219:Aspartate Aminotransferases / Q000097:blood; D005260:Female; D007413:Intestinal Mucosa / Q000473:pathology*; D008099:Liver / Q000473:pathology; D016031:Liver Transplantation; D011167:Portacaval Shunt, Surgical; D011169:Portal Vein / Q000502:physiology*; D013552:Swine; D014690:Venous Pressure
D001219:Aspartate Aminotransferases