Abstract
Background and aims
In acute, potentially reversible hepatic failure, auxiliary liver transplantation is a promising alternative approach. Using the auxiliary partial orthotopic liver transplantation (APOLT) method—the orthotopic implantation of auxiliary segments—most of the technical problems (lack of space for the additional liver mass, the portal vein reconstruction, and the venous outflow) are avoided, but extensive resections of the native liver and the graft are necessary. Erhard described the heterotopic auxiliary liver transplantation (HALT) with portal vein arterialization (PVA). Initial clinical results demonstrated that an adequate liver function can be achieved using this technique. We developed and improved a technique of HALT with flow-regulated PVA in the rat to perform further investigations. The aim of this paper is to explain in detail this improved experimental surgical technique.
Materials and methods
Liver transplantations were performed in 122 male Lewis rats: After a right nephrectomy, the liver graft, which was reduced to about 30% of the original size, was implanted into the right upper quadrant of the recipient’s abdomen. The infrahepatic caval vein was anastomosed end-to-side. The donor’s portal vein was completely arterialized to the recipient’s right renal artery in stent technique. Using a stent with an internal diameter of 0.3 mm, the flow in the arterialized portal vein was regulated to achieve physiologic parameters. The celiac trunk of the graft was anastomosed to the recipient’s aorta, end-to-side. The bile duct was implanted into the duodenum.
Results
After improvements of the surgical technique, we achieved a perioperative survival of 90% and a 6-week survival of 80% in the last 112 transplantations.
Conclusion
We developed a standardized and improved technique, which can be used for experiments of regeneration and inter-liver competition in auxiliary liver transplantation. Furthermore, this technique is suitable for the investigation of the influence of portal vein arterialization and portal hyperperfusion on liver microcirculation, function, and morphology.
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Notes
Principles of Laboratory animal care were followed and the current version of the German Law on the Protection of Animals. The experimental protocol was reviewed and approved by the Animal Care Committee of the District President of Cologne, FRG (K 40, 17/99).
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Acknowledgements
The authors thank H. J. Stoffels for his illustration. The project was supported by the Deutsche Forschungsgemeinschaft (DFG) and the Köln Fortune Program of the Faculty of Medicine, University of Cologne. K. Schleimer was supported by the Lise Meitner Fellowship of the Ministry of Science and Research of Nordrhein-Westfalen.
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Schleimer, K., Stippel, D.L., Tawadros, S. et al. Improved technique of heterotopic auxiliary rat liver transplantation with portal vein arterialization. Langenbecks Arch Surg 391, 102–107 (2006). https://doi.org/10.1007/s00423-006-0032-x
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DOI: https://doi.org/10.1007/s00423-006-0032-x