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Li J, Cai C, Guo H, Guan X, Yang L, Li Y, Zhu Y, Li P, Liu X, Zhang B. Portal vein arterialization promotes liver regeneration after extended partial hepatectomy in a rat model. J Biomed Res 2014; 29:69-75. [PMID: 25745478 PMCID: PMC4342438 DOI: 10.7555/jbr.29.20140054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/05/2014] [Accepted: 09/12/2014] [Indexed: 11/14/2022] Open
Abstract
In the current study, we sought to establish a novel rat model of portal vein arterialization (PVA) and evaluate its impact on liver regeneration after extended partial hepatectomy (PH). A total of 105 Sprague-Dawley rats were randomly assigned to three groups: 68% hepatectomy (the PH group), portal arterialization after 68% hepatectomy (the PVA group), and right nephrectomy only (the control group). Liver regeneration rate (LRR), 5-bromo-2-deoxyuridine (BrdU) labeling index, and liver functions were assessed on postoperative day 2, 7, 14 and 28. The 28-day survival rates were compared among the three groups. The 28-day survival rates were similar in all groups (P = 0.331), and the anastomotic patency was 100%. The LRR in the PVA group was significantly higher than that of the PH group within postoperative 14 days (P < 0.05). The PVA and PH group had increased serum alanine aminotransferase levels (232 ± 61 U/L and 212 ± 53 U/L, respectively) compared with the control group (101 ± 13 U/L) on postoperative day 2, whereas from postoperative day 7 to day 28 there were no differences among the three groups. Serum albumin values were higher after the PVA procedure within postoperative day 14, which gradually became comparable on postoperative day 28 among the three groups. The peaks of BrdU labeling index appeared on postoperative day 2 in all rats, and the PVA procedure was associated with increased BrdU labeling index from postoperative day 7 to 28. The 28-day survival of the PVA rats was comparable. Our findings demonstrate that the PVA procedure utilizing portal vein trunk-renal artery microvascular reconstruction promotes remnant liver regeneration and confers beneficial effects on maintaining and even optimizing liver function after extended partial hepatectomy in rats.
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Affiliation(s)
- Jian Li
- Departments of General Surgery, the 5th Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Chaonong Cai
- Departments of General Surgery, the 5th Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Hui Guo
- Departments of Radiology, the 5th Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Xiaodong Guan
- Departments of General Surgery, the 5th Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Lukun Yang
- Anesthesiology, the 5th Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Yuechan Li
- Departments of General Surgery, the 5th Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Yanhua Zhu
- Departments of General Surgery, the 5th Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Peiping Li
- Departments of General Surgery, the 5th Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Xialei Liu
- Departments of General Surgery, the 5th Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Baimeng Zhang
- Departments of General Surgery, the 5th Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
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Bhangui P, Salloum C, Lim C, Andreani P, Ariche A, Adam R, Castaing D, Kerba T, Azoulay D. Portal vein arterialization: a salvage procedure for a totally de-arterialized liver. The Paul Brousse Hospital experience. HPB (Oxford) 2014; 16:723-38. [PMID: 24329988 PMCID: PMC4113254 DOI: 10.1111/hpb.12200] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 10/27/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Portal vein arterialization (PVA) has been used as a salvage inflow technique when hepatic artery (HA) reconstruction is deemed impossible in liver transplantation (LT) or hepatopancreatobiliary (HPB) surgery. Outcomes and the management of possible complications have not been well described. METHODS The present study analysed outcomes in 16 patients who underwent PVA during the period from February 2005 to January 2011 for HA thrombosis post-LT (n = 7) or after liver resection (n = 1), during curative resection for locally advanced HPB cancers (requiring HA interruption) (n = 7) and for HA resection without reconstruction (n = 1). In addition, a literature review was conducted. RESULTS Nine patients were women. The median age of the patients was 58 years (range: 30-72 years). Recovery of intrahepatic arterial signals and PVA shunt patency were documented using Doppler ultrasound until the last follow-up (or until shunt thrombosis in some cases). Of five postoperative deaths, two occurred as a result of haemorrhagic shock, one as a result of liver ischaemia and one as a result of sepsis. The fifth patient died at home of unknown cause. Three patients (19%) had major bleeding related to portal hypertension (PHT). Of these, two underwent re-exploration and one underwent successful shunt embolization to control the bleeding. Four patients (25%) had early shunt thrombosis, two of whom underwent a second PVA. After a median follow-up of 13 months (range: 1-60 months), 10 patients (63%) remained alive with normal liver function and one submitted to retransplantation. CONCLUSIONS Portal vein arterialization results in acceptable rates of survival in relation to spontaneous outcomes in patients with completely de-arterialized livers. The management of complications (especially PHT) after the procedure is challenging. Portal vein arterialization may represent a salvage option or a bridge to liver retransplantation and thus may make curative resection in locally advanced HPB cancers with vascular involvement feasible.
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Affiliation(s)
- Prashant Bhangui
- Department of Surgery, Medanta Institute of Liver Transplantation and Regenerative MedicineDelhi, India
| | - Chady Salloum
- Department of Hepato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP)Créteil, France
| | - Chetana Lim
- Department of Hepato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP)Créteil, France
| | - Paola Andreani
- Department of Hepato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP)Créteil, France
| | - Arie Ariche
- Department of Hepato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP)Créteil, France
| | - René Adam
- Department of Hepato-Biliary Surgery and Liver Transplantation, Paul Brousse Hospital, AP-HPVillejuif, France
| | - Denis Castaing
- Department of Hepato-Biliary Surgery and Liver Transplantation, Paul Brousse Hospital, AP-HPVillejuif, France
| | - Tech Kerba
- Department of Hepato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP)Créteil, France
| | - Daniel Azoulay
- Department of Hepato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP)Créteil, France
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Wang Z, Yang L. Gastric coronary vein to portal vein reconstruction in liver transplant: case report. EXP CLIN TRANSPLANT 2014; 12:562-4. [PMID: 24918690 DOI: 10.6002/ect.2013.0186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Portal vein thrombosis is a common complication in end-stage liver diseases of candidates for liver transplant. Most portal vein thromboses can be removed with thrombectomy. However, if the thrombosis extends to the distal superior mesenteric vein, it is difficult to reconstruct the portal vein. We report herein a case of dilated gastric coronary vein to portal vein reconstruction in liver transplant. CASE REPORT During the operation, the portal vein thrombosis was confirmed; it extended to the distal superior mesenteric vein. It could not be removed, and a jumping graft vein could not be used either. The dilated gastric coronary vein was dissected. After a piggy-back caval anastomosis, the recipient gastric coronary vein was anastomosed to donor portal vein using side-to-end anastomosis. Successive ultrasound studies demonstrated patent portal anastomosis. At postoperative day 30, computed tomography scans confirmed the patency of the portal anastomosis. The patient recovered fully and at the time of this writing, was doing well 1 year after transplant. Neither ascites nor upper gastrointestinal bleeding occurred. CONCLUSIONS If complete portal vein thrombosis extends to the distal superior mesenteric vein, and a jumping graft vein cannot be applied, the recipient gastric coronary vein or other collateral varix anastomosed to the donor portal vein is an alternative.
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Affiliation(s)
- Zifa Wang
- From the Department of Transplant, California Pacific Medical Center, 2340 Clay Street, Suite 118, San Francisco, California 94115, USA and the Department of General Surgery, First Affiliated Hospital, Xinxiang Medical University, 100 Jiankang Road, Weihui, Henan 453003, China
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