Details

Autor(en) / Beteiligte

• López-Santamaria, M.
• Migliazza, L.
• Gamez, M.
• Murcia, J.
• Paz Cruz, J.A.
• Muñoz, J.
• Canser, E.
• Qi, Baoquan
• Lobato, R.
• Diaz, M.
• Tovar, J.A.

Titel

Supraceliac aortic clamping during the anhepatic phase of experimental orthotopic liver transplantation

Ist Teil von

• Journal of pediatric surgery, 1999-09, Vol.34 (9), p.1374-1377

Ort / Verlag

Philadelphia, PA: Elsevier Inc

Erscheinungsjahr

1999

Quelle

Elsevier Journal Backfiles on ScienceDirect (DFG Nationallizenzen)

Beschreibungen/Notizen

• Background: The pig tolerates simultaneous clamping of the liver pedicle and inferior vena cava poorly, so venovenous bypass has to be used during the anhepatic phase of experimental orthotopic liver transplantation (OLT). The aim of this work is to assess whether clamping of the supracœliac aorta during the anhepatic phase (AP) of experimental OLT in pigs allows transplantation in stable hemodynamic conditions. Methods: Fourteen pigs (weight, 16 to 18 kg) received whole liver grafts from 14 age-matched donors and were subsequently divided into two groups: group I, OLT without venovenous bypass during the AP, group II, OLT with supracœliac aortic clamping during the AP. Variables analyzed were cardiac output (CO) and related variables, mean systemic arterial pressure (MAP), mixed venous oxygen saturation ( S vO 2 ), hepatic artery and portal vein blood flow, systemic and hepatic O 2 supply and uptake (SḊo 2, SV̇o 2, HḊo 2, HV̇o 2, respectively), liver enzymes, glucose, creatinine, and electrolytes. Results: In group I, CO, MAP, and S vO 2 , decreased during the AP (anhepatic) in comparison with baseline (preanhepatic) values (CO, 3.60 ± 0.74, preanhepatic, v 1.21 ± 0.25 L × min −1, anhepatic; P < .05. MAP, 97 ± 12, preanhepatic, v 43 ± 17 mm Hg, anhepatic; P < .05. S vO 2 , 91.6 ± 5.6, preanhepatic v 70.0 ± 12.5%, anhepatic; P < .05), and SḊo 2/SV̇o 2 increased by 16% (preanhepatic) to 33% (anhepatic; P < .05). In group II, CO decreased during the anhepatic phase by only 21% (3.82 ± 0.81, preanhepatic, v 3.07 ± 0.99 L × min −1, anhepatic; not significant), the MAP increased significantly (100 ± 8, preanhepatic, v 135 ± 4 mm Hg, anhepatic; P < .05), and S vO 2, S D ̇ o 2, S V ̇ o 2, and S D ̇ o 2/S V ̇ o 2 remained unchanged. After revascularization, none of these variables differed significantly between groups, and levels of liver enzymes, glucose, creatinine, urea, and electrolytes were similar in both groups, both before and after transplantation. Conclusions: Experimental OLT can be carried out in pigs without venovenous bypass, but it leads to severe hemodynamic disturbances. Clamping of the supraceliac artery during the AP is well tolerated and results in excellent hemodynamic stability, so it may prove to be a useful technique in liver transplantation in animals, such as dogs or pigs, that do not tolerate simultaneous clamping of the liver pedicle and inferior vena cava as well as human beings.