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

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


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)