title: A hemodynamic, metabolic and histopathological study of a heterotopic auxiliary swine liver graft with portal vein arterialization.
abstract: BACKGROUND
  Auxiliary heterotopic liver transplantation with portal vein arterialization (AHLT-PVA) is a model that has been hardly studied, despite its therapeutic potential.
  
  
  METHODS
  Hemodynamic and biochemical characterization was carried out during graft implantation, in a pig-to-pig model (n=15 AHLT-PVA). Furthermore a histopathological study was performed to establish microscopic alterations due to PVA.
  
  
  RESULTS
  Reperfusion of the arterialized graft produced an increase in heart rate (HR) vs. baseline (P=.004) and vs. inferior vena cava clamping phase (P=.004); and a decrease in systemic vascular resistance vs. cava clamping phase (P=.021). At the end of implantation, cardiac output remained elevated (P=.001), likewise HR remained increased vs. baseline phase (P=.002). Mean arterial pressure decreased with cava clamping, but was not affected by the reperfusion of the graft, nor the skin closure. The histopathological study at 3, 10, and 21 days post-PVA revealed that functional liver structure was maintained although it is common to find foci of perilobular necrosis on day 3 (P=.049), and perilobular connective tissue proliferation at day 10 (P=.007), vs. native liver.
  
  
  CONCLUSIONS
  The described arterialized liver graft model minimizes the number of vascular anastomoses vs. previously described models. It is hemodynamically and metabolically well tolerated and the double arterial vascularization of the graft does not cause significant changes in liver histology.
authors.affiliation: Departamento de Cirugía, Cirugía Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: Olga M
authors.initials: OM
authors.lastname: Fernández-Rodríguez
authors.affiliation: Departamento de Cirugía, Cirugía Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Departamento de Cirugía, Unidad de Trasplante Hepático, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España. Electronic address: arzrios@um.es.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ríos
authors.affiliation: Departamento de Cirugía, Cirugía Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Departamento de Anestesia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Palenciano
authors.affiliation: Departamento de Cirugía, Cirugía Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Departamento de Cirugía, Unidad de Trasplante Hepático, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: Pablo
authors.initials: P
authors.lastname: Ramírez
authors.affiliation: Departamento de Medicina Nuclear, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Navarro
authors.affiliation: Departamento de Cirugía, Cirugía Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: Laura
authors.initials: L
authors.lastname: Martínez-Alarcón
authors.affiliation: Departamento de Patología, Facultad de Veterinaria, Universidad de Murcia, España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Martínez
authors.affiliation: Departamento de Medicina Nuclear, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: Teodomiro
authors.initials: T
authors.lastname: Fuente
authors.affiliation: Departamento de Medicina Interna, Unidad de Trasplante Hepático, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Pons
authors.affiliation: Departamento de Patología, Facultad de Veterinaria, Universidad de Murcia, España.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Navarro
authors.affiliation: Departamento de Hematología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: Maruja
authors.initials: M
authors.lastname: Majado
authors.affiliation: Departamento de Hematología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: Pedro
authors.initials: P
authors.lastname: Martínez
authors.affiliation: Departamento de Cirugía, Cirugía Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Departamento de Cirugía, Unidad de Trasplante Hepático, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: Pascual
authors.initials: P
authors.lastname: Parrilla
mesh_terms: D000818:Animals; D006439:Hemodynamics; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation; D011169:Portal Vein; D013552:Swine; D016042:Transplantation, Heterotopic
keywords: Anastomosis vascular; Arterialización portal; Auxiliary heterotopic liver transplantation; Biochemical assessment; Estudio histopatológico; Haemodynamic responses; Histopathological study; Portal vein arterialization; Respuesta hemodinámica; Trasplante auxiliar heterotópico hepático; Valoración bioquímica; Vascular anastomoses