Hemodynamics alterations during orthotopic liver experimental transplantation in pigs

Abstract

PURPOSE: To describe the hemodynamics alterations during orthotopic liver transplantation in pigs. METHODS: In the period from April 2004 to December 2005, forty-four female Landrace pigs, weighting between 32 and 38 Kg were undergone to orthotopic liver transplantation. The animals were divided into two groups, donor and recipient pairs, which received whole liver grafts. The surgical procedure was divided into four parts: harvested, back-table, hepatectomy of the recipient and implantation. We analyze heart rate, blood gas, mean systemic arterial pressure (MAP-mmHg), central venous pressure, pH, Na-, K+, Cl-, Ca+ and urinary output. RESULTS: The mean anhepatic time was 69 min, cold ischemia was 252.2 min and back-table was 56.6 min. Blood pressure and heart rate dropped significantly during anhepatic phase and after revascularization. Blood gas and electrolytes alterations were observed during anhepatic and reperfusion phases. Although alterations were noted during these phases, the hemodynamic status was recovered and stabilized in the end of the surgery. CONCLUSIONS: Simplified technique of liver transplant was achieved and description of hemodynamic alterations was possible in pigs.

Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt

“…Splanchnic congestion during the anhepatic phase causes venous hypertension and capillary damage that can lead to major intestinal ischemia and hemodynamic instability to the point of an irreversible shock even after organ reperfusion 7 . Since the vena cava is completely embedded in liver parenchyma, a cava-preserving piggy-back procedure is not feasible.…”

“…The total occlusion of the vena cava during the cava reconstruction phase impairs the hemodynamic stability of the pig. Although a few reports show that porcine OLTx can be accomplished during total cava and portal vein occlusion of less than 25 min 16,17 , a porto-cava-jugular bypass technique for the time of vascular reconstruction is the safer and more practical option [7][8][9]18 . In the authors' experience, a passive porto-jugular bypass is not optimal to keep the pig hemodynamically stable during the anhepatic phase.…”

Immediate graft histological assay, post pig's liver transplantation

“…They usually result from ischemia that the liver is submitted to, however, other factors as the utilized drugs and toxins may also cause them. The intra-lobular aggregated and portals of neutrophilus observed in 77.08% of the biopsies were attributed to the organ manipulation during the procedure, being this alteration denominated "surgical hepatitis" 17,18 .…”

Experimental Liver Transplantation

“…(Marino & De Luca, 1985) Some authors consider that metabolic acidosis can be avoided by administration of sodium bicarbonate before declamping and corrections of alterations in serum electrolytes. (Torres et al, 2008) Immediately after declamping of suprahepatic inferior vena cava and portal vein with subsequent revascularization of the liver, the reperfusion syndrome must be readily recognized and controlled. Swine hemodynamic status during anhepatic phase was analyzed by different authors.…”

“…Swine hemodynamic status during anhepatic phase was analyzed by different authors. (Fondevila et al 2010;Heuer et al, 2010;Torres et al, 2008) In the unfortunate case of intraoperative sudden death of the recipient the operation should be continued with the aim of improvement of surgical techniques.…”