title: Minimal portal vein stenosis is a promising preconditioning in living donor liver transplantation in porcine model.
abstract: OBJECTIVE
  The main hindrance in promoting living donor liver transplantation remains the morbi-mortality risk for the donor. Considering the opposed remodeling influence of portal and hepatic artery flows, our working hypothesis was to identify a lobar portal vein stenosis capable of inducing a contralateral liver mass compensatory enlargement, without the downstream ipsilateral atrophic response.
  
  
  METHODS
  Twenty-four pigs entered this study. Six of them were used to establish hemodynamic changes following a progressive left portal vein (LPV) stenosis, in blood flow, pressure and vessel diameter of the LPV, main portal vein and hepatic artery. Sixteen pigs were divided into 4 groups: sham operated animals, 20% LPV stenosis, 50% LPV stenosis, and 100% LPV stenosis. Daily liver biopsies were collected until post-operative day 5 to investigate liver regeneration and atrophy (Ki67, STAT3, LC3, and activated caspase 3) according to the degree of LPV stenosis. Finally, changes in liver volumetry after 20% LPVS were investigated.
  
  
  RESULTS
  A 20% LPV stenosis led to dilatation of the hepatic artery and a subsequent four-fold increase in hepatic arterial flow. Concomitantly, liver regeneration was triggered in the non-ligated lobe and the cell proliferation peak, 5 days after surgery, was comparable to that obtained after total LPV ligation. Moreover, 20% LPV stenosis preconditioning did not induce left liver atrophy contrary to 50 and 100% LPV stenosis.
  
  
  CONCLUSIONS
  A 20% LPV stenosis seems to be the adequate preconditioning to get the remnant liver of living donor ready to take on graft harvesting without atrophy of the future graft.
authors.affiliation: Aix-Marseille University, Department of General Surgery and Liver Transplantation, Hôpital de la Conception Marseille, France. Electronic address: emilie.gregoire@ap-hm.fr.
authors.forename: E
authors.initials: E
authors.lastname: Gregoire
authors.affiliation: Aix-Marseille University, Experimental Interventional Imaging Laboratory, European Center for Medical Imaging Research, Marseille, France.
authors.forename: P
authors.initials: P
authors.lastname: Brige
authors.affiliation: Aix-Marseille University, Department of General Surgery and Liver Transplantation, Hôpital de la Conception Marseille, France.
authors.forename: L
authors.initials: L
authors.lastname: Barbier
authors.affiliation: Aix-Marseille University; URMITE, CNRS UMR 6236-IRD 198, Marseille, France; Laboratoire de Biochimie et de Biologie Moléculaire, Hôpital de la Conception Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Buffat
authors.affiliation: Aix-Marseille University, Experimental Interventional Imaging Laboratory, European Center for Medical Imaging Research, Marseille, France.
authors.forename: A
authors.initials: A
authors.lastname: Coppola
authors.affiliation: Aix-Marseille University, Department of General Surgery and Liver Transplantation, Hôpital de la Conception Marseille, France.
authors.forename: J
authors.initials: J
authors.lastname: Hardwigsen
authors.affiliation: Aix-Marseille University, Department of General Surgery and Liver Transplantation, Hôpital de la Conception Marseille, France.
authors.forename: Y P
authors.initials: YP
authors.lastname: Le Treut
authors.affiliation: Aix-Marseille University, Experimental Interventional Imaging Laboratory, European Center for Medical Imaging Research, Marseille, France.
authors.forename: V
authors.initials: V
authors.lastname: Vidal
authors.affiliation: Aix-Marseille University, Experimental Interventional Imaging Laboratory, European Center for Medical Imaging Research, Marseille, France.
authors.forename: P H
authors.initials: PH
authors.lastname: Rolland
mesh_terms: D000818:Animals; D049109:Cell Proliferation; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods; D006499:Hepatic Artery / Q000473:pathology; D019194:Ischemic Preconditioning / Q000379:methods*; D008026:Ligation; D008102:Liver Circulation; D008115:Liver Regeneration; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D009929:Organ Size; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D034421:Sus scrofa / Q000601:surgery