Abstract
Fulminant hepatic failure is usually fatal without liver transplantation; however, orthotopic liver transplantation is often difficult to perform due to the high risk of coagulopathy and the development of multiple organ failure. Auxiliary heterotopic partial liver transplantation (APLT), however, has the potential to provide an effective hepatic support system considering that the host liver is left in situ and the surgical procedure is less invasive. In this report, we describe the beneficial effects of performing 60% APLT on the hepatic function and survival of pigs with acute hepatic failure induced by hepatic artery ligation. The pigs were divided into a control group of nine animals (group 1) that had portal vein and hepatic artery ligation with a side-to-side portacaval shunt, and an APLT group of seven animals (group 2) that had portal vein and hepatic artery ligation with APLT. The two left lateral lobes of the donor liver were resected, reducing the liver weight to about 60%, and the graft was placed in the right subhepatic space. No deaths occurred intraoperatively. In group 1, eight pigs died of massive liver necrosis within 48 h and one died between 48 and 72 h (median surivival 23 h). In group 2, two pigs died within 72 h due to preservation or anesthetic problems, but five survived for more than 3 days (median survival 13.4 days), with a significant difference between the two groups (P<0.05). One animal was killed 30 days after APLT and excellent graft function was demonstrated by the synthesis of clotting factors, ammonia detoxification, and glucohomeostasis. Moreover, evidence of hepatic regeneration was found in the transplanted livers. These results indicate that APLT provides metabolic support and improves survival in animals with induced acute liver failure.
Similar content being viewed by others
References
Bithmuth H, Castaring D, Ericzon BG, Otte JB, Rolles K, Ringe B, Sloof M (1985) Hepatic transplantation in Europe. First report of the European Liver Transplant Registry. Lancet 2:279–283
Welch CS (1955) A note on transplantation of the whole liver in dogs. Transplant Bull 2:54–55
Slapak M, Beaudoin JG, Lee HM, Hume DM (1970) Auxiliary liver homotransplantation; a new technique and an evaluation of current techniques. Arch Surg 100:31–41
Lilly JR, Anderson KD, Hill JL, Rossen SB, Randolph JG (1972) Auxiliary liver transplantation in acute liver failure. J Pediatr Surg 7:492–498
Terpstra OT, Reuvers CB, Schalm SW (1988) Auxiliary heterotopic liver transplantation. Transplantation 45:1003–1007
Blankensteijn JD, Schalm SW, Terpstra OT (1992) New aspects of heterotopic liver transplantation. Transplant Int 5:43–50
Terpstra OT, Schalm SW, Weimar W, Willemse PJA, Baumgartner D, Groenland THN, tenKate FWJ, Porte RJ, deRave S, Reuvers CB, Stibbe J, Terpstra JL (1988) Auxiliary partial liver transplantation for end-stage chronic liver disease. N Engl J Med 319:1507–1511
Reuvers CB, Terpstra OT, Boks AL, deGroot GH, Jeekel J, tenKate FWJ, Kooy PPM, Schalm SW (1985) Auxiliary transplantation of part of the liver improves survival and provides metabolic support in pigs with acute liver failure. Surgery 98:914–921
Marubayashi S, Asahara T, Ono E, Watanabe H, Matsusaka T, Yano K, Yamanaka K, Shimatani K, Shinhara R, Hayamizu K, Hoshino S, Urushihara T, Ikeda M, Katayama K, Nitta K, Yahata H, Fukuda Y, Dohi K (1993) Study of auxiliary partial liver transplantation in pig (in Japanese with English abst.) Ishoku (Jpn J Transplantation) 28:693–698
Marchioro TL, Porter KA, Brown BI, Otte JB, Starzl TE (1967) The effect of partial portacaval transplantation on the canine liver. Surgery 61:723–732
Starzl TE, Porter KA, Francavilla A (1978) A hundred years of the hepatotrophic controversy. In: Porter KA, Whelan J (eds) Hepatotrophic controversy (Ciba Foundation Symposium 55). Elsevier Biomedical, Amsterdam, pp 111–129
Willemse PJ, Ausema L, Terpstra OT, Krenning EP, tenKate FWJ, Schalm SW (1992) Graft regeneration and host liver atrophy after auxiliary heterotopic liver transplantation for chronic liver failure. Hepatology 15:54–57
Then PK, Feldman L, Broelsch CE (1989) Flow and vascular resistance measurements in auxiliary liver segments transplanted in orthotopic position. Transplant Proc 21:2378–2380
Madern GC, Terpstra OT, Sinaasappel M, Provoost AP, Rothuizen J, Molenaar JC (1991) Heterotopic liver transplantation corrects the inborn error of hepatic metabolism in a dog model. Transplant Proc 23:716–717
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Marubayashi, S., Asahara, T., Ono, E. et al. Auxiliary heterotopic partial liver transplantation in pigs with acute liver failure. Surg Today 25, 429–432 (1995). https://doi.org/10.1007/BF00311820
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00311820