How can we share the portal blood inflow in auxiliary partial heterotopic liver transplantation without portal hypertension?

BACKGROUND

Auxiliary partial heterotopic liver transplantation (APHLT) may be an attractive treatment for fulminant hepatic failure in which recovery of the host liver is expected. We investigated the functional relationship between an auxiliary heterotopic partial liver graft and the host liver with or without portal hypertension in pigs.

METHODS

Sixteen pigs underwent hepatic artery ligation and APHLT; in addition, various degrees of portal hypertension were created by banding the host portal vein. The pigs were randomly divided into three groups: group A (n = 5), the host portal vein was not banded; group B (n = 6), the host portal vein was banded to make the host portal pressure higher than that of the graft by 2 mm Hg; and group C (n = 5), the host portal vein was banded to make the host portal pressure the same as that of the graft.

RESULTS

All of the pigs in group A had necrotic and atrophied grafts with graft portal vein thrombosis and well-hypertrophied host livers. All of the pigs in group B had well-functioning grafts and necrotic and atrophied host livers. Three of the five pigs in group C had well-functioning grafts and host livers, although the remaining two pigs exhibited the same results as those in group A.

CONCLUSIONS

APHLT could be a valuable alternative treatment for temporary support in fulminant hepatic failure. However, if the recipient does not exhibit portal hypertension, the host portal vein should be banded to make the host portal pressure at least the same as that of the graft.