Does Arterialization of Portal Vein Have Any Effects in Large-for-Size Liver Transplantation? Hemodynamic, Histological, and Biomolecular Experimental Studies

Author(s)

Torres, Rafael Rodrigues ; Aoun Tannuri, Ana Cristina ; Serafini, Suellen ; Belon, Alessandro ; Goncalves, Josiane Oliveira ; di Loreto, Celso ; Tannuri, Uenis ^{[1, 2]}

Affiliation

^[1] Univ Sao Paulo, Med Sch, Pediat Surg Div, Pediat Liver Transplantat Unit, Ave Dr Arnaldo 455, 4o Andar Sala 4109, BR-01246903 Sao Paulo, SP - Brazil

^[2] Univ Sao Paulo, Med Sch, Lab Res Pediat Surg LIM 30, Ave Dr Arnaldo 455, 4o Andar Sala 4109, BR-01246903 Sao Paulo, SP - Brazil

• Document type: Journal article
• Source: Journal of Investigative Surgery; DEC 2021.
• Web of Science Citations: 0

Abstract

Background: In pediatric liver transplantation, the optimal size of the transplanted liver ranges between 0.8% and 4.0% of the recipient's weight. Sometimes, the graft weight exceeds this upper limit, characterizing the large-for-size condition potentially associated with reduced blood flow and worsening of ischemia-reperfusion injury. Therefore, it would be beneficial to increase the portal flow through arterialization of the portal vein. Materials and methods: Fifteen pigs underwent large-for-size liver transplants. They were divided into two groups: control (CTRL 6 animals - conventional technique) and arterialization - a shunt was established between the portal vein and the splenic artery (ART 9 animals). Hemodynamic, biochemical, histological, and molecular variables were compared. Results: Arterialization resulted in a significant increase in portal vein pressure but no changes in other hemodynamic variables, as shown in the analysis of variance. It was observed lower ALT values (p = 0.007), with no differences regarding the values of blood pH and lactate (p = 0.54 and p = 0.699 respectively) or histological variables (edema, steatosis, inflammation, necrosis, and IRI - p = 1.0, p = 0.943, p = 0.174, p = 0.832, p = 0.662, respectively). The molecular studies showed significantly increased expression of IL6 after 3 hours of reperfusion (p = 0.048) and decreased expression of ICAM immediately after reperfusion (p = 0.03). The regression analysis suggested a positive influence of portal flow and pressure on biochemical parameters. Conclusion: Arterialization of the portal vein showed no histological, biochemical, or molecular benefits in large-for-size transplantation. (AU)

• FAPESP's process: 16/19098-9 - Large for size liver transplantation with portal vein arterialization: hemodynamic, histologic and biomolecular study
• Grantee: Nelson Elias Mendes Gibelli
• Support Opportunities: Regular Research Grants