Heterotopic Auxiliary Rat Liver Transplantation With Flow-regulated Portal Vein Arterialization in Acute Hepatic Failure

Abstract

In acute hepatic failure auxiliary liver transplantation is an interesting alternative approach. The aim is to provide a temporary support until the failing native liver has regenerated.1-3 The APOLT-method, the orthotopic implantation of auxiliary segments-averts most of the technical problems. However this method necessitates extensive resections of both the native liver and the graft. A liver graft reduced to 30 % of its original size, was heterotopically implanted in the right renal region of the recipient after explantation of the right kidney. The infra-hepatic caval vein of the graft was anastomosed with the infrahepatic caval vein of the recipient. The arterialization of the donor's portal vein was carried out via the recipient's right renal artery with the stent technique. The blood-flow regulation of the arterialized portal vein was achieved with the use of a stent with an internal diameter of 0.3 mm. The celiac trunk of the graft was end-to-side anastomosed with the recipient's aorta and the bile duct was implanted into the duodenum. A subtotal resection of the native liver was performed to induce acute hepatic failure. 7In this manner 112 transplantations were performed. The perioperative survival rate was 90% and the 6-week survival rate was 80%. Six weeks after operation, the native liver regenerated, showing an increase in weight from 2.3±0.8 g to 9.8±1 g. At this time, the graft's weight decreased from 3.3±0.8 g to 2.3±0.8 g.We were able to obtain promising long-term results in terms of graft morphology and function. HALT with flow-regulated PVA reliably bridges acute hepatic failure until the native liver regenerates. Video LinkThe video component of this article can be found at

Chinese Herb Jiedu Huayu Granules Inhibiting Immune and Inflammatory Response of Rats with Acute Liver Failure by Regulating the NF-κB Signaling Pathway

“…Acute liver failure (ALF), mainly created by a series of liver diseases, is a liver syndrome that remains to have a great mortality. The mortality of ALF reached 60%-80% [ 1 , 2 ]. The patients with ALF exhibit the features of a proinflammatory state of local liver inflammation, vascular endothelial dysfunction, and systemic inflammatory response syndrome (SIRS) [ 3 ].…”

Surgical Models to Explore Acellular Liver Scaffold Transplantation: Step-by-Step

“…The anatomic region most used in heterotopic transplants in experimental microsurgery consists of one of the two renal positions. [18][19][20] Thus, the graft is heterotopically transplanted into the left or right kidney position of the recipient animal. In this case, the renal vein (RV) and the renal artery (RA) of the recipient animal are preserved and dissected and from different types of anastomoses can be connected to the graft vessels to be transplanted.…”

“…Surgical strategies such as PV arterialization, PV reconstruction without arterial flow, dual arterial blood supply were performed. 12,[19][20][21] Furthermore, after Cuff technique development, the procedure was simplified, decreasing the operation time and improving the survival rate. Focusing on translational medicine aspects, the heterotopic transplantation can be useful to some diseases, such as liver failure.…”