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portal vein arterialization technique for liver transplantation patients

World Journal of Gastroenterology 2014年第34期20卷 12359-12362页

作者： Kun Zhang Yi Jiang Li-Zhi Lv Qiu-Cheng Cai Fang Yang Huan-Zhang Hu Xiao-Jin Zhang Department of Hepatobiliary Surgery Fu Zhou General HospitalNan Jing Military Command

Liver transplantations were performed on two patients with hepatic failure caused by liver *** obsolete thrombi and portal venous sclerosis were observed in the major portal veins of both *** arteria colica media of one recipient and the portal vein of the donor were anastomosed *** hepatic artery of the first donor was anastomosed end-to end with the gastroduodenal artery of the first recipient;meanwhile,the portal vein of the second donor was simultaneously anastomosed end-to-end with the common hepatic artery of the second *** blood flow of the portal vein,the perfusion of the donor liver and liver function were satisfactory after *** vein arterialization might be an effective treatment for patients whose portal vein reconstruction was difficult.

关键词： portal vein arterialization Liver transplantation portal vein Postoperative complication Donor

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portal vein arterialization promotes liver regeneration after extended partial hepatectomy in a rat model

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The Journal of Biomedical Research 2015年第1期29卷 69-75页

作者： Jian Li Chaonong Cai Hui Guo Xiaodong Guan Lukun Yang Yuechan Li Yanhua Zhu Peiping Li Xialei Liu Baimeng Zhang Departments of General Surgery the 5th Affiliated HospitalSun Yat-sen University Departments of Radiology the 5th Affiliated HospitalSun Yat-sen University Departments of Anesthesiology the 5th Affiliated HospitalSun Yat-sen University

In the current study, we sought to establish a novel rat model of portal vein artefialization （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 fight 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.

关键词： portal vein arterialization microsurgery hepatectomy liver regeneration liver function

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portal vein arterialization in 25 liver transplant recipients:A Latin American single-center experience

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World Journal of Transplantation 2024年第2期14卷 135-147页

作者： Nicolas Andres Cortes-Mejia Diana Fernanda Bejarano-Ramirez Juan Jose Guerra-Londono Diego Rymel Trivino-Alvarez Raquel Tabares-Mesa Alonso Vera-Torres Division of Anesthesiology Critical Care Medicineand Pain MedicineThe University of Texas MD Anderson Cancer CenterHoustonTX 77030United States Transplant and Hepatobiliary Surgery Department Fundacion Santa Fe de BogotaBogota 110111Colombia General Surgery Department Fundacion Santa Fe de BogotaBogota 110111Colombia

BACKGROUND portal vein arterialization(PVA)has been used in liver transplantation(LT)to maximize oxygen delivery when arterial circulation is compromised or has been used as an alternative reperfusion technique for complex portal vein thrombosis(PVT).The effect of PVA on portal perfusion and primary graft dysfunction(PGD)has not been *** patients receiving PVA and LT at the Fundacion Santa Fe de Bogota between 2011 and 2022 were *** account for the time-sensitive effects of graft perfusion,patients were classified into two groups:prereperfusion(pre-PVA),if the arterioportal anastomosis was performed before graft revascularization,and postreperfusion(post-PVA),if PVA was performed *** pre-PVA rationale contemplated poor portal hemodynamics,severe vascular steal,or ***-PVA was considered if graft hypoperfusion became *** interventions were attempted before PVA.

关键词： Liver transplantation portal vein arterialization Arteriovenous anastomoses portal hypertension portal vein thrombosis Spontaneous portosystemic shunts Vascular steal phenomenon Primary graft dysfunction Early allograft dysfunction

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Effects of partial portal vein arterialization on the hilar bile duct in a rat model

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Hepatobiliary & Pancreatic Diseases International 2011年第5期10卷 533-538页

作者： Shao-Hua Guo, Chong-Hui Li,Yong-Liang Chen, Jian-Ning Song,Ai-Qun Zhang and Cheng Zhou Department of Hepatobiliary Surgery (Guo SH, Li CH, Chen YL, Song JN, Zhang AQ and Zhou C) and Department of Surgical Oncology (Guo SH), General Hospital of PLA, Beijing 100853, China Department of Hepatobiliary Surgery General Hospital of PLA Beijing 100853 China Department of Surgical Oncology General Hospital of PLA Beijing 100853 China

BACKGROUND: Liver revascularization is frequently required during the enlarged radical operation for hilar cholangio carcinoma involving the hepatic artery. Researchers have carried out a number of experiments applying partial porta vein arterialization (PVA) in clinical practice. In this study we aimed to establish a theoretical basis for clinical application o partial PVA and to investigate the effects of partial PVA on ra hilar bile duct and hepatic functions. METHODS: Thirty rats were randomly and equally assigned into 3 groups: control (group A), hepatic artery ligation+bile duct recanalization (group B), and partial PVA+bile duc recanalization (group C). Proliferation and apoptosis o rat hilar bile duct epithelial cells, arteriolar counts of the peribiliary plexus (PBP) of the bile duct wall, changes in serum biochemistry, and pathologic changes in the bile duc were assessed 1 month after operation. RESULTS: The proliferation of hilar bile duct epithelial cells in group B was greater than in groups A and C (P0.05), but the coun was lower in group B than in group A (P<0.01). No statistically significant differences in alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and albumin were found in the 3 groups. The gamma-glutamyltransferase value was higher in group B than in groups A and C (P<0.01) The hepatic tissues of groups A and C showed no significan abnormality. Chronic inflammatory changes in the hilar bile duct walls were observed only in group B. CONCLUSION: Partial PVA can restore the arterial blood supply of the hilar bile duct and significantly extenuate the injury to hilar bile duct epithelial cells resulting from hepatic artery ligation.

关键词： portal vein arterialization biliary epithelial cells peribiliary plexus

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From portal to splanchnic venous thrombosis:What surgeons should bear in mind

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World Journal of Hepatology 2014年第8期6卷 549-558页

作者： Quirino Lai Gabriele Spoletini Rafael S Pinheiro Fabio Melandro Nicola Guglielmo Jan Lerut Starzl Unit of Abdominal Transplantation University Hospitals Saint-LucUniversitéCatholique Lou-vainB-1200 BrusselsBelgium Oxford Transplant Centre Churchill HospitalOxford University Hospitals NHS TrustOxford OX3 7LEUnited Kingdom Department of Gastroenterology University of Sao Paulo Medical School05508-070 Sao PauloBrazil Department of General Surgery and Organ Transplantation University SapienzaUmberto I Hospital00186 RomeItaly

The present study aims to review the evolution of surgical management of portal(PVT) and splanch-nic venous thrombosis(SVT) in the context of liver transplantation over the last 5 decades. PVT is more commonly managed by endovenous thrombectomy, while SVT requires more complex technical expedients. Several surgical techniques have been proposed, such as extensive eversion thrombectomy, anastomosis to collateral veins, reno-portal anastomosis, cavo-portal hemi-transposition, portal arterialization and combined liver-intestinal transplantation. In order to achieve satisfactory outcomes, careful planning of the surgical strategy is mandatory. The excellent results that are ob-tained nowadays confirm that, even extended, splanch-nic thrombosis is no longer an absolute contraindication for liver transplantation. Patients with advanced portal thrombosis may preferentially be referred to specialized centres, in which complex vascular approaches and even multivisceral transplantation are performed.

关键词： Liver transplantation portal vein thrombosis Splanchnic vein thrombosis Thrombectomy Vascular graft Spleno-renal shunt Cavo-portal hemi-transposition portal vein arterialization Intestinal transplantation Multi-visceral transplant

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