Allogenic split liver transplantation in pigs

Koh, Young Taeg; Suh, Kyung Suk; Roh, Hye Rin; Lee, Kwang Woong; Ha, Jongwon; Jung, Sung Eun; ZhengKuhn, Longxian; Lee, Kuhn Uk

Abstract

BACKGROUND/AIMS: The shortage of cadaveric liver donor is particularly critical for children. Split liver transplantation, not only overcomes the drawbacks of reduced size grafts and living donor transplantation for children but also increases the total number of donor organs. The purpose of this study is to examine the technical feasibility of split liver transplantation in pig.
METHODS
Nine pigs(3 donors and 6 recipients weighing 19-33Kg) were used. In donor pigs, the liver was divided between right medial lobe and left medial lobe without inflow occlusion under general anesthesia. Left liver was harvested first and then right liver was harvested as usual manner. One recipient pig underwent left lobectomy and left graft were transplanted orthotopically (auxiliary partial orthotopic liver transplantation(APOLT)). For right graft, conventional orthotopic liver transplantation were done. Veno-venous bypass was not performed. Instead, superior and inferior mesenteric arteries were clamped temporarily. RESULT: There was no anhepatic time when using left graft. Cold ischemic time were 2hr 35min, 1hr 21min, and 1hr 5min, respectively. When using right graft, anhepatic time was 72min, 54min, and 49min, respectively. Cold ischemic time was 5hr 17min, 6hr 32min, and 4hr 18min, respectively. Biochemical laboratory data(WBC, hemoglobin, platelet, ALT/AST, LDH, prothrombin time) after reperfusion 1 hour showed good graft function in all transplant pigs and were better in the recipient pigs taking left graft than right graft. Histologic findings at 4 hours after reperfusion show normal appearance except mild ischemic change around central vein. All transplant pigs survived over 24 hours without any major complication.
CONCLUSION
APOLT for left graft and conventional liver transplantation for right graft without venovenous bypass were successful in pig. In situ split liver transplantation in pig is technically feasible procedure and this model is suitable for future studies of split liver transplantation.