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Updated: Mar 2, 2026

Heterotopic Auxiliary Rat Liver Transplantation With Flow-regulated Portal Vein Arterialization in Acute Hepatic Failure
Published on: September 13, 2014
Hepatic Hemodynamics and Portal Flow Modulation: The A2ALL Experience
Jean C Emond1, Nathan P Goodrich, James J Pomposelli
11 Department of Surgery, Columbia University Medical Center, New York, NY. 2 Arbor Research Collaborative for Health, Ann Arbor, MI. 3 Department of Transplantation, Lahey Hospital and Medical Center, Burlington, MA. 4 Department of Surgery, Northwestern University, Chicago, IL. 5 Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. 6 Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. 7 Department of Surgery, University of Pennsylvania, Philadelphia, PA. 8 Department of Surgery, University of California at San Francisco, San Francisco, CA. 9 Department of Transplant Surgery, Virginia Commonwealth University, Richmond, VA. 10 Department of Transplant Surgery, Beth Israel Deaconess Department of Surgery, Harvard University, Boston, MA. 11 Department of Surgery, University of Colorado, Denver, CO. 12 Liver Diseases Research Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD. 13 Department of Biostatistics, University of Michigan, Ann Arbor, MI. 14 Department of Surgery, University of Michigan, Ann Arbor, MI.
Portal flow modulation in adult liver transplants may increase graft dysfunction but does not impact long-term survival. Further research is needed to define optimal protocols for liver transplantation.
Area of Science:
- Hepatology
- Transplantation Surgery
- Vascular Surgery
Background:
- The Adult-to-Adult Living Donor Liver Transplantation Cohort Study investigated hepatic blood flow and portal flow modulation.
- There is an increasing trend towards using smaller and left lobe grafts in liver transplantation.
Purpose of the Study:
- To evaluate the impact of portal flow modulation on graft outcomes in adult living donor liver transplantation.
- To understand the effects of altered hepatic hemodynamics on graft function and survival.
Main Methods:
- 274 adult living donor liver transplant recipients were enrolled.
- Hepatic hemodynamics were recorded post-reperfusion, with 57 portal flow modulations performed on 52 subjects.
- Graft dysfunction and survival rates were compared between modulated and unmodulated groups.
Main Results:
- Portal flow modulation successfully lowered portal pressure in 68% of subjects.
- Inconsistent effects on hepatic arterial and portal flow were observed post-modulation.
- Graft dysfunction was higher in modulated subjects (31%) versus unmodulated (18%), but 3-year graft survival was similar.
Conclusions:
- Portal flow modulation shows potential for managing portal pressure but requires further investigation.
- A standardized protocol with defined indications for portal flow modulation is necessary.
- More research is needed to clarify the precise role and benefits of portal flow modulation in liver transplantation.
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