This study reviews the evaluation and results of a new liver transplantation technique for small-for-size grafts with portomesenteric disconnection. Twenty Large-White pigs underwent heterotopic liver transplantation after a mesocaval shunt, ligation of the superior mesenteric vein downstream from the shunt, and ligation of the recipient portal vein near the native liver. The donor-to-recipient weight ratio was 24%, and the graft-to-recipient weight ratio was 0.6%. In five control pigs, no mesocaval shunt was performed. The mesocaval shunt provided diversion of 60% of the splanchnic blood flow. The median survival of study pigs was 39 days (range, 8 to 98). Median serum bilirubin levels at 1 week were 12 micromol/L (range, 4 to 59). At autopsy, graft weight was increased to 2.7 times the initial weight and histologic findings were normal. In the control group, all pigs died quickly of acute splanchnic congestion. Portomesenteric disconnection was effective to achieve survival of small-for-size grafts in pig liver transplantation.

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This pilot study suggests that increasing tacrolimus dosage could be considered as treatment against early acute rejection episodes including the severe grade.

Patients with end-stage liver disease due to chronic hepatitis B virus (HBV) infection with a persistent viral replication are generally denied liver transplantation (LT). We report the case of a patient who presented with the emergence of a YMDD escape mutant virus under lamivudine treatment, and developed terminal liver failure requiring LT. Pre-LT introduction of adefovir led to only a mild decrease in replication. The patient was treated with a combination of intravenous hepatitis B immune globulin (HBIG) that was started perioperatively, and also continued lamivudine and adefovir after LT. One year after LT, there was no evidence of HBV infection recurrence. This observation suggests that persistent high HBV replication might not be a contra-indication to LT, providing adequate and effective prophylaxis is given, using HBIG and antiviral drug combination therapy.

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