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Heterotopic Auxiliary Rat Liver Transplantation With Flow-regulated Portal Vein Arterialization in Acute Hepatic Failure
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Hepatic flow optimization in full right split liver transplantation.

Stefano Di Domenico1, Enzo Andorno, Giovanni Varotti

  • 1Department of General Surgery and Organ Transplantation, San Martino University Hospital, Largo R. Benzi 10, 16132 Genoa, Italy.

World Journal of Gastrointestinal Surgery
|August 24, 2011
PubMed
Summary
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Split liver transplantation using combined techniques can improve graft function in adults. This approach optimizes blood flow and reduces the risk of small for size syndrome, enhancing transplant success.

Area of Science:

  • Hepatology
  • Transplant Surgery
  • Vascular Surgery

Background:

  • Split liver transplantation expands donor availability for adult recipients.
  • Physiological limitations of partial liver grafts, particularly small for size syndrome, hinder application.
  • Existing techniques in living donor liver transplantation aim to prevent graft dysfunction.

Purpose of the Study:

  • To report the first application of synergistic approaches to optimize hepatic hemodynamics in a split liver graft for two adult recipients.
  • To evaluate the efficacy of combined strategies in preventing graft dysfunction after split liver transplantation.

Main Methods:

  • Utilized a full right liver graft (segments 5-8) without the middle hepatic vein.
  • Preserved minor and accessory inferior hepatic veins by splitting the vena cava, with V5 and V8 anastomosed using a donor venous iliac patch.
Keywords:
Portal flowProstaglandinSplit liverTransplantationUltrasound

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  • Implemented inflow modulation via splenic artery ligation and intraportal infusion of prostaglandin E1 (PGE1).

    • Main Results:

    • Achieved immediate graft function with normalization of liver tests within 7 days post-transplantation.
    • Nineteen months post-transplant, liver function remained normal, with graft volume at 110% of the recipient's standard liver volume.
    • Demonstrated successful graft function and volume maintenance in the recipient.

    Conclusions:

    • Optimizing venous outflow, inflow modulation, and intraportal PGE1 infusion represent a valuable synergistic strategy.
    • This combined approach may effectively prevent graft dysfunction in split liver transplantation for two adults.
    • The described synergistic strategy can potentially increase the safety of split liver grafts for adult recipients.