title: Liver Autotransplantation in Pigs without Venovenous Bypass: A Simplified Model using a Supraceliac Aorta Cross-Clamping Maneuver.
abstract: BACKGROUND
  The pig is an essential model for liver transplantation research and training. However, it develops hemodynamic instability during the anhepatic phase, requiring a short anhepatic phase or an extracorporeal circulation not appropriate for training purposes because it increases the risk of intraoperative complications. In this article we describe an economical and reproductive experimental model for training surgeon fellows in liver transplantation, without veno-venous bypass, using a supraceliac aortic cross-clamping maneuver.
  
  
  METHODS
  After liver liberation, we cross-clamped the supraceliac aorta and cross-clamped and divided the infrahepatic inferior vena cava (IVC), bile duct (BD), hepatic artery (HA), portal vein (PV), and suprahepatic IVC. We rapidly removed and flushed the liver ex situ, repositioned it orthotopically, and performed anastomosis in suprahepatic IVC, infrahepatic IVC and PV, reperfusing the liver. Lastly, we anastomosed the HA and BD. We also performed pulmonary artery catheter exams and recovery blood samples serially before and after graft reperfusion (beginning of anesthesia = basal; 5 min after reperfusion and 120 min after reperfusion = end-point) for hemodynamic and metabolic assessment.
  
  
  RESULTS
  Transplantation fellows were able to perform the operations assisted by a senior surgeon. The median procedure time was 211 min (188-233 min). One pig died due to hemorrhage and 5 remained alive for up to 2 h after liver reperfusion, achieving at this time normal hemodynamic and metabolic parameters.
  
  
  CONCLUSIONS
  This model is suitable for training and experimentation, avoids venovenous bypass, is low cost, avoids immunological reaction, and prevents hemodynamic and metabolic complications.
authors.affiliation: Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Bernardo F
authors.initials: BF
authors.lastname: Canedo
authors.affiliation: Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Flavio H
authors.initials: FH
authors.lastname: Galvao
authors.affiliation: Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Liliana
authors.initials: L
authors.lastname: Ducatti
authors.affiliation: Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Lucas S
authors.initials: LS
authors.lastname: Nacif
authors.affiliation: Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Sergio
authors.initials: S
authors.lastname: Catanozi
authors.affiliation: Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Wangles V
authors.initials: WV
authors.lastname: Soler
authors.affiliation: Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Eleazar
authors.initials: E
authors.lastname: Chaib
authors.affiliation: Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Luiz A
authors.initials: LA
authors.lastname: D'Albuquerque
authors.affiliation: Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Wellington
authors.initials: W
authors.lastname: Andraus
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D001011:Aorta / Q000601:surgery*; D001652:Bile Ducts / Q000601:surgery; D005260:Female; D006439:Hemodynamics; D006499:Hepatic Artery / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008953:Models, Anatomic; D023421:Models, Animal; D011169:Portal Vein / Q000601:surgery; D013552:Swine; D014182:Transplantation, Autologous; D014682:Vena Cava, Inferior / Q000601:surgery