Effect of Partial Portal Arterialization on Graft Survival in Experimental Liver Transplantation

Yoo, Chang Hyun; Rim, Dae Sik; Kim, Jong Min

Abstract

PURPOSE: In liver transplantation, low portal perfusion pressure may result in underperfusion of grafts and be the cause of primary nonfunction. Partial arterialization of portal vein could preserve graft perfusion. Up till now, there have been several clinical cases of temporary or permanent portal arterialization in liver transplantation.
METHODS
In this study, we designed rat model for evaluating the effect of portal arterialization to improve survival of the under-perfused graft. Partial heterotopic non-regenerative liver transplantation was used with portal inflow only from inferior vena cava, which is known as portal under-perfusing liver transplantation model. Partial portal arterialization was performed by fenestration of the common wall between the IVC and the aorta through venotomy which was made for portacaval anastomosis.
RESULTS
Immediate after arterialization, satisfactory macroscopic and duplex ultrasonographic liver perfusion were seen and the arterialized-graft survival was significantly improved to 95% (19/20) vs. 35% (7/20) of nonarterialized grafts. At 2-week after transplantation, the arterialized liver graft was atrophied showed normal gross appearance. The histopathologic examination with light microscope revealed no significant pathologic abnormality.
CONCLUSION
Partial portal arteria;ization improved graft-survival of the under-perfusing liver grafts significantly and not affects the histologic hepatic structure adversely.