Experimental partial liver transplantation using gradual occlusion of the portal vein for pediatric patient

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Orthotopic replacement of the diseased liver by a whole liver obtained from a heart beating cadaver is the standard technique for liver transplantation. However, the shortage of a size-matched donor liver has contributed to the difficulty in pediatric liver transplantation. A partial lever transplntation is one solution of this problem. A new technique of orthotopic partial liver transplantation, which partially retains the host lever, has been developed in the mongrel dog.We pefrormed two different methods for diversion of the portal venous inflow from the recipient's liver to the graft's one.Gradual occlusion group: The left lobe of the donor liver was transplanted orthotopically in the space after removal of the left and central lobes of the recipient. An Ameroid constricotor was placed on the recipient's right portal vein to occlude the recipient's portal inflow gradually. Right hepatic duct and right hepatic artery were ligated. 18 of 33 dogs in this group survived for more than 2 … More 4 hours and the mean survival time was 7.7 5.8 days(n=18). One dog survived for 19 days after transplantation. Graft of the longest survived dog showed almost normal appearance and slight mononuclear cell infiltration in the periportal area. The weight of the graft doubled at autopsy. On the other hand, the recipient's remnant liver revealed atrophy and necrosis of the hepatocyte.Ligation group: The recipient's right portal vein was ligated instead of the gradual occlusion. Of 11 dogs, 8 dogs survived for more than 24 hours and mean survival time was 4.5 3.6 days(n=8). It seemed that the survival rate of the gradual occlusion group was better than that of ligation group.Cycloporin-A(5 mg/kg/day) and methylprednisolone(1-10 mg/kg/day) were used as immunosup-pression in the both groups.Since this technique does not tequire complete occlusion of either caval vein or the portal vein, external veno-venous shunt is unnecessary, Furthermore the total hepatectomy is avoided and graft failure does not mean the recipient's deterioration. This method has the advantages of both patial orthotopic and heterotopoic liver transplantation. Less