AUXILIARY HETEROTOPIC PARTIAL LIVER-TRANSPLANTATION IN PIGS WITH ACUTE LIVER-FAILURE

Fulminant hepatic failure is usually fatal without liver transplantati on; however, orthotopic liver transplantation is often difficult to pe rform due to the high risk of coagulopathy and the development of mult iple organ failure. Auxiliary heterotopic partial liver transplantatio n (APLT), however, has the potential to provide an effective hepatic s upport system considering that the host liver is left in situ and the surgical procedure is less invasive. In this report, we describe the b eneficial effects of performing 60% APLT on the hepatic function and s urvival of pigs with acute hepatic failure induced by hepatic artery l igation. The pigs were divided into a control group of nine animals (g roup 1) that had portal vein and hepatic artery ligation with a side-t o-side portacaval shunt, and an APLT group of seven animals (group 2) that had portal vein and hepatic artery ligation with APLT. The two le ft lateral lobes of the donor liver were resected, reducing the liver weight to about 60%, and the graft was placed in the right subhepatic space. No deaths occurred intraoperatively. In group 1, eight pigs die d of massive liver necrosis within 48 h and one died between 48 and 72 h (median survival 23 h). In group 2, two pigs died within 72h due to preservation or anesthetic problems, but five survived for more than 3 days (median survival 13.4 days), with a significant difference betw een the two groups (P < 0.05). One animal was killed 30 days after APL T and excellent graft function was demonstrated by the synthesis of cl otting factors, ammonia detoxification, and glucohomeostasis. Moreover , evidence of hepatic regeneration was found in the transplanted liver s. These results indicate that APLT provides metabolic support and imp roves survival in animals with induced acute liver failure.