Nakano T, Lai C-Y, Goto S, Hsu L-W, Huang T-L, Chen T-Y, Tsang L-C, Chen C-L, Cheng Y-F
Liver Transplantation Program, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Niao-Sung, Taiwan.
Transplant Proc. 2008 Oct;40(8):2515-6. doi: 10.1016/j.transproceed.2008.07.056.
Distal splenorenal shunt effectively controls bleeding from esophageal and gastric varices but has a different effect on liver transplantation. This study sought to develop an animal model in rats to mimic the recipient with a portosystemic shunt and to investigate its hemodynamic consequences on liver transplantation.
We prepared 5 groups of allogeneic or syngeneic rat liver transplantation models with versus without portosystemic shunt, to investigate its effects on graft survival and portal flow. To explore the effects of excessive portal flow on graft survival in small-for-size liver transplantation, we transplanted partial liver grafts into syngeneic recipients.
In allogeneic combinations, graft survival among the shunt group was shortened compared with their control counterparts. The graft survival of the large shunt group was significantly lower than that of a small shunt or without shunt group in a syngeneic liver transplantation model. Portal blood pressure of the large shunt group was significantly lower than that of the small shunt group. In contrast, excessive portal flow resulted in dysfunction of liver graft in small-for-size liver transplantation.
These results suggested that reduction in portal flow by portosystemic shunt lead to an acceleration of acute rejection and subsequent liver graft dysfunction, but it may be applicable to regulate the excessive portal flow in small-for-size transplantations. This study showed a valuable model mimicking the recipient with a portosystemic shunt.
远端脾肾分流术可有效控制食管和胃静脉曲张出血，但对肝移植有不同影响。本研究旨在建立大鼠动物模型以模拟存在门体分流的肝移植受者，并研究其对肝移植血流动力学的影响。
我们制备了5组同种异体或同基因大鼠肝移植模型，分为有或无门体分流组，以研究其对移植物存活和门静脉血流的影响。为探讨在小体积肝移植中门静脉血流过多对移植物存活的影响，我们将部分肝移植物移植到同基因受者体内。
在同种异体组合中，分流组的移植物存活时间较其相应对照组缩短。在同基因肝移植模型中，大分流组的移植物存活率显著低于小分流组或无分流组。大分流组的门静脉血压显著低于小分流组。相反，在小体积肝移植中，门静脉血流过多导致肝移植物功能障碍。
这些结果表明，门体分流导致门静脉血流减少会加速急性排斥反应及随后的肝移植物功能障碍，但它可能适用于调节小体积肝移植中过多的门静脉血流。本研究展示了一种模拟存在门体分流的肝移植受者的有价值模型。
