Faculdade de Medicina da Universidade de São Paulo, Pediatric Liver Transplantation Unit and Laboratory of Research in Pediatric Surgery (LIM 30), Pediatric Surgery Division, São PauloSP, Brazil.
Clinics (Sao Paulo). 2013;68(8):1152-6. doi: 10.6061/clinics/2013(08)15.
The ideal ratio between liver graft mass and recipient body weight for liver transplantation in small infants is unknown; however, if this ratio is over 4%, a condition called large-for-size may occur. Experimental models of large-for-size liver transplants have not been described in the literature. In addition, orthotopic liver transplantation is marked by high morbidity and mortality rates in animals due to the clamping of the venous splanchnic system. Therefore, the objective of this study was to create a porcine model of large-for-size liver transplantation with clamping of the supraceliac aorta during the anhepatic phase as an alternative to venovenous bypass.
Fourteen pigs underwent liver transplantation with whole-liver grafts without venovenous bypass and were divided into two experimental groups: the control group, in which the weights of the donors were similar to the weights of the recipients; and the large-for-size group, in which the weights of the donors were nearly 2 times the weights of the recipients. Hemodynamic data, the results of serum biochemical analyses and histological examination of the transplanted livers were collected.
The mortality rate in both groups was 16.5% (1/7). The animals in the large-for-size group had increased serum levels of potassium, sodium, aspartate aminotransferase and alanine aminotransferase after graft reperfusion. The histological analyses revealed that there were no significant differences between the groups.
This transplant method is a feasible experimental model of large-for-size liver transplantation.
在小婴儿进行肝移植时，肝移植物质量与受体体重的理想比例尚不清楚；但是，如果该比例超过 4%，可能会出现“大小肝”的情况。文献中尚未描述“大小肝”肝移植的实验模型。此外，由于门脉内脏系统的夹闭，原位肝移植在动物中具有较高的发病率和死亡率。因此，本研究的目的是创建一种猪的“大小肝”肝移植模型，在无肝期夹闭腹腔干，作为静脉-静脉旁路的替代方法。
14 只猪进行了无静脉-静脉旁路的全肝移植，分为两组实验：对照组，供体体重与受体体重相似；“大小肝”组，供体体重接近受体体重的 2 倍。收集了血流动力学数据、血清生化分析结果以及移植肝脏的组织学检查结果。
两组的死亡率均为 16.5%（1/7）。“大小肝”组动物在移植物再灌注后血清钾、钠、天门冬氨酸氨基转移酶和丙氨酸氨基转移酶水平升高。组织学分析显示两组间无显著差异。
这种移植方法是一种可行的“大小肝”肝移植实验模型。
