Minimal portal vein stenosis is a promising preconditioning in living donor liver transplantation in porcine model.

Abstract

BACKGROUND & AIMS:

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: E Gregoire, P Brige, L Barbier, C Buffat, A Coppola, J Hardwigsen, Y P Le Treut, V Vidal, P H Rolland
• Journal: Journal of hepatology (J Hepatol) Vol. 61 Issue 1 Pg. 59-66 (Jul 2014) ISSN: 1600-0641 [Electronic] Netherlands
• PMID: 24662302 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Topics

• Animals
• Cell Proliferation
• Hepatectomy (adverse effects, methods)
• Hepatic Artery (pathology)
• Ischemic Preconditioning (methods)
• Ligation
• Liver Circulation
• Liver Regeneration
• Liver Transplantation (adverse effects, methods)
• Living Donors
• Organ Size
• Portal Vein (pathology, surgery)
• Risk Factors
• Sus scrofa (surgery)