Auxiliary liver transplantation: how to improve regeneration of the native liver by surgery

Abstract

The technical factors which could influence regeneration of the native liver (NL) in auxiliary liver transplantation (ALT) for fulminant hepatic failure (FHF) are not well known. We studied NL regeneration according to the location of graft anastomosis in the recipient's portal system (superior mesenteric vein versus portal vein), and graft weight (50 ' 740 reduced-size versus full-size graft) in a rat model of ALT with 80 % reduction of the NL, and graft arterialization. NL regeneration was significantly more obvious when the graft was anastornosed on the recipient's superior mesenteric vein, thus establishing venous flow to the NL from the pancreas, the spleen, and the stomach, and when a full-size graft was used. The influence of portal venous flow on NL regeneration, assessed by [3H]-thymidine incorporation, was measurable as early as day 2. Both technical variables in combination resulted in significantly greater regeneration (ratio weight of NL/body weight at day 30: 2.32 * 0.68 % versus 1.21 f. 0.63 % respectively, P = 0.02). Early preservation of portal flow to the NL is advisable to maximize NL regeneration in ALT. In any case, this regeneration is not impeded by the use of large auxiliary grafts.

Effects of dual arterial blood supply on liver regeneration in the graft and the host following heterotopic auxiliary liver transplantation

“…The implanted liver was able to maintain normal liver function ( 15 ). The total weight of the donor and the recipient livers was significantly higher compared to the weight of standard liver required by the recipient, which was similar to the findings of Sauvanet et al ( 14 ). However, other studies ( 11 , 16 ) demonstrated that the total weight of the liver required by the recipients following transplantation was regulated by body weight and the final ratio of liver weight to body weight was constant.…”

“…Sauvanet et al ( 14 ) reported that a whole or half transplanted liver to an ectopic site may promote regeneration of the host liver in their established rat model following acute liver failure induced by 80% liver resection treated by auxiliary liver transplantation. Even with the same surgical procedure, whole-liver transplants may more effectively promote the regeneration of the host liver in the short term compared to partial liver transplants.…”