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Titolo:
Directing portal flow is essential for graft survival in auxiliary partialheterotopic liver transplantation in the dog
Autore:
de Jonge, J; Madern, GC; Terpstra, OT; Sinaasappel, M; Molenaar, JC; Provoost, AP; Tilanus, HW;
Indirizzi:
Sophia Childrens Univ Hosp, Erasmus Med Ctr, Dept Surg, Rotterdam, Netherlands Sophia Childrens Univ Hosp Rotterdam Netherlands Rotterdam, Netherlands Sophia Childrens Univ Hosp, Erasmus Med Ctr, Dept Paediat Surg, Rotterdam,Netherlands Sophia Childrens Univ Hosp Rotterdam Netherlands Rotterdam,Netherlands Sophia Childrens Univ Hosp, Erasmus Med Ctr, Dept Paediat, Rotterdam, Netherlands Sophia Childrens Univ Hosp Rotterdam Netherlands Rotterdam, Netherlands Leiden Univ, Med Ctr, Dept Surg, Leiden, Netherlands Leiden Univ Leiden Netherlands Med Ctr, Dept Surg, Leiden, Netherlands
Titolo Testata:
JOURNAL OF PEDIATRIC SURGERY
fascicolo: 8, volume: 34, anno: 1999,
pagine: 1265 - 1268
SICI:
0022-3468(199908)34:8<1265:DPFIEF>2.0.ZU;2-4
Fonte:
ISI
Lingua:
ENG
Soggetto:
FULMINANT-HEPATITIS; FAILURE; EXPERIENCE; DEFICIENCY; DONOR; RATS; PIGS;
Keywords:
auxiliary partial heterotopic liver transplantation; dog; portal vein; banding; inborn error of metabolism;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
24
Recensione:
Indirizzi per estratti:
Indirizzo: Tilanus, HW Erasmus Univ, Hosp Dijkzigt, Dept Surg, Dr Molewaterplein 40, NL-3015 GD Rotterdam, Netherlands Erasmus Univ Dr Molewaterplein 40 Rotterdam Netherlands NL-3015 GD
Citazione:
J. de Jonge et al., "Directing portal flow is essential for graft survival in auxiliary partialheterotopic liver transplantation in the dog", J PED SURG, 34(8), 1999, pp. 1265-1268

Abstract

Background/Purpose: Auxiliary liver transplantation is an attractive alternative for orthotopic liver transplantation in patients with certain inbornerrors of metabolism of the liver in which complete resection of the liveris unnecessary or even contraindicated. Because in these diseases portal hypertension is mostly absent, finding a balance in portal blood distribution between native liver and graft is complicated. The objective of this study was to investigate requirements for long-term (180 days) graft survival in auxiliary partial heterotopic liver transplantation (APHLT) in a dog model. Methods: A metabolic defect was corrected in 26 dalmation dogs with a 60% beagle heterotopic auxiliary liver graft. Four groups of different portal inflow were studied. In the ligation group the portal vein to the host liverwas ligated. In the split-flow group graft and host liver received separate portal inflow. In the banding group the distribution of the portal flow was regulated with an adjustable strapband and in the free-flow group the portal blood was allowed to flow randomly to host or graft liver. Results: Metabolic correction increased in all groups after transplantation from 0.19 +/- 0.02 to 0.70 +/- 0.05 (P < .0001) but remained significantly better in the ligation and split-flow groups (graft survival, 135 +/- 27 and 144 +/- 31 days). In the banding group metabolic correction decreased significantly after 70 days, and although the grafts kept some function for 155 +/- 14 days, in 4 of 6 dogs portal thrombosis was found. In the free-flow group, competition for the portal blood led to reduced correction within12 days and total loss of function in 96 +/- 14 days. Graft function also was assessed with technetium (Tc) 99m dimethyl-iminodiacetic acid uptake. Agood linear association between HIDA uptake and metabolic correction was observed (r = 0.74; P < .0005). Grafts that contributed more than 15% to thetotal uptake of HIDA showed biochemical correction. This indicates a critical graft mass of about 15% to 20% of the hepatocyte volume to correct thismetabolic defect. Conclusion: Auxiliary partial heterotopic liver transplantation can be a valuable alternative treatment for inborn errors of hepatic metabolism if the native liver and the graft receive separate portal blood inflow. Copyright (C) 1999 by W.B. Saunders Company.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/07/20 alle ore 22:38:14