Large for size liver transplantation with portal vein arterialization: hemodynamic, histologic and biomolecular study

• Grant number: 16/19098-9
• Support Opportunities: Regular Research Grants
• Start date: November 01, 2017
• End date: October 31, 2019
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Nelson Elias Mendes Gibelli
• Grantee: Nelson Elias Mendes Gibelli
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil
• Associated researchers: Alessandro Rodrigo Belon ; Ana Cristina Aoun Tannuri ; Josiane de Oliveira Gonçalves ; Maria Cecília de Mendonça Coelho ; Rafael Rodrigues Torres ; Suellen Serafini ; Uenis Tannuri

Abstract

INTRODUCTION: In liver transplantation, the optimal graft size ranges between 0.8% and 4% of the recipient's body weight (graft to body weight ratio - GBWR). However, grafts are often larger than 4% of the body weight when the recipient is a child weighting less than 10kg. Usually, we call this disproportion large for size. In this situation, there is a relative hypoperfusion in the portal vein territory, which could worsen the ischemia/reperfusion injury.Ischemia/reperfusion injury is a Kupffer cell-mediated inflammatory response due to the release of reactive oxygen species in the liver parenchyma and recruitment of polymorphonuclear leukocytes and T CD4+ lymphocytes, perpetuating the injury even after blood flow is reestablished.Since hypoperfusion tends to aggravate the ischemia/reperfusion lesion in the large for size graft, increasing portal blood oxygenation by establishing an anastomosis between the portal system and the arterial system could be beneficial - this is called portal vein arterialization.This is an experimental study using pigs, which are considered a good model for the assessment of liver transplant results in general and, specifically, ischemia/reperfusion injury. OBJECTIVES: To assess the effects of portal vein arterialization on the ischemia/reperfusion injury, in transplants with large for size grafts.METHODS: Twelve transplants will be performed in pigs, using grafts from donors weighting about 60% more than the recipient. In six of these transplants, a catheter will be used to establish a communication between the portal vein and the splenic artery. Hemodynamic parameters, gene expression and inflammatory markers will be assessed. (AU)

Scientific publications

(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)

TORRES, RAFAEL RODRIGUES; AOUN TANNURI, ANA CRISTINA; SERAFINI, SUELLEN; BELON, ALESSANDRO; GONCALVES, JOSIANE OLIVEIRA; DI LORETO, CELSO; TANNURI, UENIS. Does Arterialization of Portal Vein Have Any Effects in Large-for-Size Liver Transplantation? Hemodynamic, Histological, and Biomolecular Experimental Studies. Journal of Investigative Surgery, DEC 2021. (16/19098-9)