Wirsching Andrea, Melloul Emmanuel, Lezhnina Ksenia, Buzdin Anton A, Ogunshola Omolara O, Borger Pieter, Clavien Pierre-Alain, Lesurtel Mickaël
Swiss Hepato-Pancreatico-Biliary and Transplantation Center, Department of Surgery, University Hospital Zurich, Zürich, Switzerland.
Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland.
Surgery. 2017 Jul;162(1):68-81. doi: 10.1016/j.surg.2017.01.032. Epub 2017 Apr 14.
Temporary portal vein embolization may be a safe alternative to permanent portal vein embolization. Such a new approach could be applied in living-related liver transplantation to increase graft volume before procurement. The impact of temporary portal vein embolization on occluded liver after recanalization, however, has never been assessed. Using a mouse model of temporary portal vein embolization, we investigated (1) the efficiency of temporary portal vein embolization in inducing nonoccluded liver hypertrophy and (2) the regeneration potential and functional recovery of embolized liver after recanalization.
Selected portal vein branches were occluded using gelfoam powder (temporary portal vein embolization) or embospheres (permanent portal vein embolization), n = 5/group. Magnetic resonance volumetry and angiography were used to determine volumes of the liver lobe and portal vein branch recanalization. In order to assess the functional and regenerative capacity of occluded liver lobes, nonoccluded lobes were resected 14 days (timespan of complete portal vein recanalization) after temporary portal vein embolization or permanent portal vein embolization. Subsequently, RNA sequencing was performed to compare the signaling pathways of early liver regeneration among the groups.
Hypertrophy of nonoccluded lobes 30 days after temporary portal vein embolization and permanent portal vein embolization was similar (103 ± 26% and 129 ± 13%, P = .11). Temporary occluded lobes increased their volumes after nonoccluded lobes resection, reaching similar liver-to-body-weight ratios and similar functional capacity after 7 days compared with partial hepatectomy controls (4 ± 1% vs 4 ± 1%, P = .22). Partial hepatectomy activated similar signaling pathways in temporary occluded and native liver.
Temporary portal vein embolization induces hypertrophy of contralateral liver lobes similarly to permanent portal vein embolization in mice. This experimental work suggests that temporary portal vein embolization may be considered as a possibility in living liver donation, because regenerative and functional capacities are preserved in the embolized liver after recanalization in mice.
临时门静脉栓塞可能是永久性门静脉栓塞的一种安全替代方法。这种新方法可应用于活体肝移植，以在获取供肝前增加移植肝体积。然而，临时门静脉栓塞再通后对被栓塞肝脏的影响尚未得到评估。我们使用临时门静脉栓塞的小鼠模型，研究了（1）临时门静脉栓塞诱导非栓塞侧肝脏肥大的效率，以及（2）再通后栓塞肝脏的再生潜力和功能恢复情况。
使用明胶海绵粉末（临时门静脉栓塞）或栓塞微球（永久性门静脉栓塞）闭塞选定的门静脉分支，每组n = 5只。采用磁共振容积测量和血管造影来确定肝叶体积和门静脉分支再通情况。为了评估被栓塞肝叶的功能和再生能力，在临时门静脉栓塞或永久性门静脉栓塞后14天（门静脉完全再通的时间跨度）切除非栓塞肝叶。随后，进行RNA测序以比较各组早期肝再生的信号通路。
临时门静脉栓塞和永久性门静脉栓塞后30天，非栓塞肝叶的肥大情况相似（分别为103±26%和129±13%，P = 0.11）。在切除非栓塞肝叶后，临时被栓塞的肝叶体积增加，与部分肝切除对照组相比，7天后达到相似的肝体重比和相似的功能能力（分别为4±1%和4±1%，P = 0.22）。部分肝切除术在临时被栓塞的肝脏和正常肝脏中激活了相似的信号通路。
在小鼠中，临时门静脉栓塞与永久性门静脉栓塞一样能诱导对侧肝叶肥大。这项实验研究表明，临时门静脉栓塞在活体肝捐赠中可能是一种可行的方法，因为在小鼠再通后，被栓塞肝脏的再生和功能能力得以保留。
