Studies of Hepatic Function in Dogs with Eck Fistula or Portacaval Transposition

Silen, William; Mawdsley, Dean L.; Weirich, William L.; Harper, Harold A.

doi:10.1001/archsurg.1957.01280120142017

Cited by 48 publications

(8 citation statements)

References 7 publications

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“…These findings are in accordance with observations reported by others [27], and have been explained by both the portosystemic shunt itself and a loss of hepatic mass after the PCS [8], As suggested by observations in experimental animal models of hepatic coma [24,25] and in patients with hepatic encephalopathy [2,9,20], ammonia appears to play a central role in the pathogenesis of hepatic encephalopathy. A close connection has been recently proposed between ammonia and the altered amino acid levels in plasma and CSF during the development of hepatic coma [10].…”

Section: Discussionsupporting

confidence: 92%

Effect of ammonia on plasma and cerebrospinal fluid amino acids in dogs with and without portacaval anastomoses

et al. 1985

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To elucidate the possible connection between ammonia-induced changes of plasma and cerebrospinal fluid (CSF) amino acid levels and the development of hepatic encephalopathy in dogs, beagle dogs were given an ammonium acetate infusion both before and following portacaval shunt (PCS). During ammonia-induced coma and after recovery in the dogs prior to PCS the plasma and CSF concentrations of most amino acids were decreased. Following PCS the plasma and CSF concentrations of the aromatic amino acids (AAA), phenylalanine and tyrosine, increased and the levels of the branched chain amino acids (BCAA), valine, leucine, and isoleucine, decreased during ammonia-induced coma. The CSF/plasma molar ratio for the AAA exhibited a marked increase after recovery as compared to the value during coma in the Eck-fistula dogs. With respect to the AAA, no correlation was observed between signs of neurologic impairment in the animals and the following parameters: glutamine and methionine levels of CSF, and the plasma molar ratio (Formula: see text). The data obtained do not support the hypothesis that high concentrations of phenylalanine and tyrosine in the brain may be primarily responsible for altered neurotransmission leading to the development of hepatic encephalopathy.

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Section: Discussionsupporting

confidence: 92%

Effect of ammonia on plasma and cerebrospinal fluid amino acids in dogs with and without portacaval anastomoses

et al. 1985

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“…Moreover, in our experience, HPCS did not jeopardize graft function nor regeneration. Theoretically, graft regeneration may be impaired by a side-to-side portocaval shunt (27). In our G2 patients, mean overall regeneration rates were even higher in the shunted patients than in those without portal flow diversion.…”

Section: Discussionmentioning

confidence: 55%

Effects of Hemi-Portocaval Shunts For Inflow Modulation on the Outcome of Small-for-Size Grafts in Living Donor Liver Transplantation

Troisi

Ricciardi

Smeets

et al. 2005

American Journal of Transplantation

237

251

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Graft hyperperfusion in small-for-size grafts (SFSG) is considered the main causal factor of small-for-size syndrome (SFSS). We compared SFSG with a graft-torecipient body ratio ≤0.8, with and without graft inflow modulation (GIM) by means of a hemi-portocaval shunt (HPCS). Thirteen patients underwent adult-toadult living donor liver transplantation (AALDLT): G1, n = 5 [4 right livers (RL) and 1 left liver (LL)] without GIM, and G2, n = 8 (4 RL and 4 LL) with GIM. In G2 patients, portal vein flow (PVF) was significantly reduced by HPCS: 190 ± 70 mL/min/100 g liver in G2 vs. 401 ± 225 ml/min in G1 (p = 0.002). One-and 6-month post-transplantation graft volume/standard liver volume (GV/SLV) ratio was of 72% and 79.5% in G1; 80% and 101% in G2 (p = ns). SFSS was observed in three G1 recipients (who were retransplanted), but in none of the G2 patients. At 1-year, patient and graft survival was respectively of 40% and 20% in G1, 87.5% and 75% in G2 (p = 0.024 and 0.03).It is concluded that drastic reduction of PVF by means of HPCS improves overall patient and graft survival by averting the occurrence of SFSS. Graft inflow modulation through HPCS reduces the risk of complications when transplanting SFSG in adult recipients.

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“…61,62 Only in the last 10 or 15 years has it been realized that subtle but cumulatively massive changes in hepatic function are caused by portal diversion and for the most part by the bypassing of endogenous insulin. These alterations are so sweeping that an all-inclusive description would require a discussion of virtually every facet of hepatic physiology and metabolism.…”

Section: Biochemical Parametersmentioning

confidence: 99%

The ECK fistula in animals and humans

Starzl¹

1983

Current Problems in Surgery

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Studies of Hepatic Function in Dogs with Eck Fistula or Portacaval Transposition

Cited by 48 publications

References 7 publications

Effect of ammonia on plasma and cerebrospinal fluid amino acids in dogs with and without portacaval anastomoses

Effect of ammonia on plasma and cerebrospinal fluid amino acids in dogs with and without portacaval anastomoses

Effects of Hemi-Portocaval Shunts For Inflow Modulation on the Outcome of Small-for-Size Grafts in Living Donor Liver Transplantation

The ECK fistula in animals and humans

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