Liver transplantation in pigs with small-for-size grafts: effect of portocaval shunt

Small-for-size livers are associated with graft dysfunction, probably due to portal hyperperfusion. Modulation of the recipient portal inflow is a new option in these cases. This article sought to analyze the effect of portocaval shunt in small-for-size liver grafts in pigs. Twelve liver transplants were performed in white pigs. The donors' mean weight was 10 kg and the recipient's mean weight was 34 kg. In all cases a standard technique was utilized. A portocaval shunt was added on the back-table in six cases. One hour after the procedure, the livers were sent for histologic examination. In all six cases without a portocaval shunt, the livers showed hemorrhagic necrosis, which was not observed in any of the six livers with a portocaval shunt. In small-for-size liver grafts in pigs, a portocaval shunt prevents hemorrhagic necrosis.