Olga M Fernández-Rodríguez1, Antonio Ríos2, Carlos Palenciano3, Pablo Ramírez4, José Luis Navarro5, Laura Martínez-Alarcón1, Carlos Martínez6, Teodomiro Fuente5, José Antonio Pons7, José Antonio Navarro6, Maruja Majado8, Pedro Martínez8, Pascual Parrilla4. 1. Departamento de Cirugía, Cirugía Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España. 2. 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. 3. 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. 4. 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. 5. Departamento de Medicina Nuclear, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España. 6. Departamento de Patología, Facultad de Veterinaria, Universidad de Murcia, España. 7. Departamento de Medicina Interna, Unidad de Trasplante Hepático, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España. 8. Departamento de Hematología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
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.
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.