Basic Research
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2005; 11(44): 6954-6959
Published online Nov 28, 2005. doi: 10.3748/wjg.v11.i44.6954
Excessive portal flow causes graft failure in extremely small-for-size liver transplantation in pigs
Hong-Sheng Wang, Nobuhiro Ohkohchi, Yoshitaka Enomoto, Masahiro Usuda, Shigehito Miyagi, Takeshi Asakura, Hiroo Masuoka, Takashi Aiso, Keisuke Fukushima, Tomohiro Narita, Hideyuki Yamaya, Atsushi Nakamura, Satoshi Sekiguchi, Naoki Kawagishi, Akira Sato, Susumu Satomi
Hong-Sheng Wang, Yoshitaka Enomoto, Masahiro Usuda, Shigehito Miyagi, Takeshi Asakura, Hiroo Masuoka, Takashi Aiso, Keisuke Fukushima, Tomohiro Narita, Hideyuki Yamaya, Atsushi Nakamura, Satoshi Sekiguchi, Naoki Kawagishi, Akira Sato, Susumu Satomi, Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
Nobuhiro Ohkohchi, Department of Surgery, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8577, Japan
Author contributions: All authors contributed equally to the work.
Supported by Grants-in-Aid for Scientific Research from the Ministry of Education, Science, and Culture of Japan, the Ministry of Welfare of Japan, and by a grant from Graduate School of Medicine, Tohoku University
Correspondence to: Nobuhiro Ohkohchi, Department of Surgery, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8577, Japan. nokuchi3@md.tsukuba.ac.jp
Telephone: +81-29-8353221 Fax: +81-29-8353222
Received: April 28, 2005
Revised: June 3, 2005
Accepted: June 9, 2005
Published online: November 28, 2005
Abstract

AIM: To evaluate the effects of a portocaval shunt on the decrease of excessive portal flow for the prevention of sinusoidal microcirculatory injury in extremely small-for-size liver transplantation in pigs.

METHODS: The right lateral lobe of pigs, i.e. the 25% of the liver, was transplanted orthotopically. The pigs were divided into two groups: graft without portocaval shunt (n = 11) and graft with portocaval shunt (n = 11). Survival rate, portal flow, hepatic arterial flow, and histological findings were investigated.

RESULTS: In the group without portocaval shunt, all pigs except one died of liver dysfunction within 24 h after transplantation. In the group with portocaval shunt, eight pigs survived for more than 4 d. The portal flow volumes before and after transplantation in the group without portocaval shunt were 118.2±26.9 mL/min/100 g liver tissue and 270.5±72.9 mL/min/100 g liver tissue, respectively. On the other hand, in the group with portocaval shunt, those volumes were 124.2±27.8 mL/min/100 g liver tissue and 42.7±32.3 mL/min/100 g liver tissue, respectively (P<0.01). As for histological findings in the group without portocaval shunt, destruction of the sinusoidal lining and bleeding in the peri-portal areas were observed after reperfusion, but these findings were not recognized in the group with portocaval shunt.

CONCLUSION: These results suggest that excessive portal flow is attributed to post transplant liver dysfunction after extreme small-for-size liver transplantation caused by sinusoidal microcirculatory injury.

Keywords: Hyperperfusion syndrome; Liver regeneration; Portocaval shunt; Postoperative liver dysfunction; Sinusoidal microcirculatory injury; Small-for-size liver transplantation