Arterialization of the Portal Vein in Orthotopic and Auxiliary Liver Transplantation

Erhard, J.; Länge, R.; Giebler, R.; Rauen, Ursula; Groot, Herbert de; Eigler, F. W.

doi:10.1097/00007890-199510000-00020

Cited by 54 publications

(60 citation statements)

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“…13 However, the results were poorer than those with APOLT and OLT owing to an increased incidence of primary nonfunction and portal vein thrombosis. 10 In 1998, Erhard et al 8,9 reported the first 4 cases of AHLT with PVA 8,9 ; only 1 of those patients was a long-term survivor with his NL. Since then, this is the first case reported by another group.…”

Section: Discussionmentioning

confidence: 99%

“…These experiences and our own unpublished cases showed that a liver graft with PVA in orthotopic position can achieve normal function without architectural damage. 8,16 AHLT with PVA has the following advantages over APOLT: no hepatectomy of the NL is required, and the portal triad is left untouched; thus, there is no competition for portal venous flow between the graft and NL. The conditions for regeneration of the NL are optimal because all liver parenchyma with all portal venous flow are left intact.…”

Section: Discussionmentioning

confidence: 99%

“…Auxiliary heterotopic liver transplantation (AHLT) with portal vein arterialization (PVA) has several advantages over APOLT: NL resection is not required, and the hepatic hilum is left untouched; therefore, the chances of liver regeneration are optimal. 8,9 We describe the successful application of emergency AHLT with PVA in a young patient who developed toxic fulminant hepatic failure caused by tuberculostatic drugs. …”

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Auxiliary heterotopic liver transplantation with portal vein arterialization for fulminant hepatic failure

et al. 2000

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Auxiliary liver transplantation for patients with fulminant hepatic failure supports the patient's failing liver for a period of time until the native liver (NL) has recovered and immunosuppression can be withdrawn. Auxiliary heterotopic liver transplantation (AHLT) with portal vein arterialization (PVA) has several advantages over auxiliary orthotopic liver transplantation: NL resection is not required, and the hepatic hilum is left untouched; thus, the chances of liver regeneration are optimal. The successful application of emergency AHLT with PVA in a young patient who developed toxic fulminant hepatic failure caused by tuberculostatic drugs is described. Two and one-half months after the procedure, the NL had completely regenerated; the graft was removed, and immunosuppression was suspended. (Liver Transpl 2000;6: 805-809.)A uxiliary liver transplantation (ALT) for patients with fulminant hepatic failure supports the patient's failing liver for a period of time until the native liver (NL) has recovered. 1 A multicenter European study showed that in two thirds of the patients, liver regeneration occurred and immunosuppression could be withdrawn. 2 Auxiliary partial orthotopic liver transplantation (APOLT) has been the more commonly used technique. [3][4][5][6][7] However, this procedure is technically more difficult than orthotopic liver transplantation (OLT) because recipient hemihepatectomy is required for implantation of the partial liver graft. Auxiliary heterotopic liver transplantation (AHLT) with portal vein arterialization (PVA) has several advantages over APOLT: NL resection is not required, and the hepatic hilum is left untouched; therefore, the chances of liver regeneration are optimal. 8,9 We describe the successful application of emergency AHLT with PVA in a young patient who developed toxic fulminant hepatic failure caused by tuberculostatic drugs. Case ReportA 25-year-old black man, an illegal immigrant from an African country, was admitted to our unit with acute liver failure from toxic hepatitis. The patient had been diagnosed with tuberculous pleural effusion and treated with rifampin, 600 mg/d; isoniazid, 250 mg/d; and pyrazinamide, 1,500 mg/d. Twenty days later, he presented with a high fever, headache, vomiting, arthromyalgia, and confusion. Laboratory blood tests showed the following values: aspartate aminotransferase (AST), 11,505 U/L; amylase, 493 U/L; lipase, 3.451 U/L; creatine kinase, 1,286 U/L; international normalized ratio, 2.32; blood urea nitrogen (BUN), 46 mg/dL; and creatinine, 1.6 mg/dL. Cerebrospinal fluid and cranial computed tomography results were normal. A diagnosis of fulminant hepatic failure caused by hepatotoxic antituberculous medications was made, and the patient was referred to our unit.On admission, the patient presented with grade I encephalopathy. Blood analyses showed the following values: bilirubin, 1.6 mg/dL; AST, 7,570 U/L; prothrombin time, 30%; creatinine, 1.6 mg/dL; and negative serologic test results for viral hepatitis A, B, and C. Over the following ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Auxiliary heterotopic liver transplantation with portal vein arterialization for fulminant hepatic failure

et al. 2000

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“…The benefit is claimed to be due to a reduction in the duration of the anhepatic phase and stable portal reperfusion. Erhard et al [4] showed good results using a permanent PVA procedure in which the portal blood flow was tapered to 1500-1800 ml/min, permitting not only recovery of graft function but also long-term adequate liver function. Performed in life-threatening, clinical situations, this represented the first time that permanent PVA was done without deterioration in liver function or the development of neurological complications.…”

Section: Discussionmentioning

confidence: 99%

“…[lo] described a permanent arterialization to increase the portal perfusion in cases of low flow, and recently, Erhard et al [4] reported long-term clinical results in three cases of successful, total, permanent PVA.…”

Section: Introductionmentioning

confidence: 99%

Arterialization of the portal vein in pediatric liver transplantation A Report of two cases

Troisi¹,

Kerremans²,

Mortier

et al. 1998

Transplant Int

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Portal vein arterialization (PVA) is an acquired concept in shunt surgery for portal hypertension. This technique, recently described as both a temporary and permanent procedure in adult liver transplantation, is reported by the authors in two cases of pediatric transplantation. The indication was low portal blood flow after reperfusion with poor graft function due to persistence of spontaneous retroperitoneal venous shunts. In both cases described, PVA allowed for satisfactory macroscopic liver reperfusion. The increase in portal blood flow from 150 to 500 ml/min in the second patient enabled the liver to be reperfused correctly and led to successful transplantation. The graft function in both cases improved in the 1st postoperative week, but thrombosis of the PVA occurred in the 1st patient 2 months after transplantation. Signs of hepatic hyperarterialization occurred in the second patient and this necessitated a dearterialization of the portal vein 2 weeks later. Although the benefit of this procedure appears to be beyond doubt in the immediate postoperative period, we have no data on long-term arterialization. We do think that PVA can be performed in pediatric liver transplantation, but it may need to be done only in special, individual situations when no valid alternative can be proposed, such as in the absence of a mesenteric vein and/or the presence of spontaneous retroperitoneal venous shunts.

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Technical considerations in liver transplantation: What a hepatologist needs to know (and every surgeon should practice)

2005

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Arterialization of the Portal Vein in Orthotopic and Auxiliary Liver Transplantation

Cited by 54 publications

References 0 publications

Auxiliary heterotopic liver transplantation with portal vein arterialization for fulminant hepatic failure

Auxiliary heterotopic liver transplantation with portal vein arterialization for fulminant hepatic failure

Arterialization of the portal vein in pediatric liver transplantation A Report of two cases

Technical considerations in liver transplantation: What a hepatologist needs to know (and every surgeon should practice)

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