AUXILIARY PARTIAL ORTHOTOPIC LIVER-TRANSPLANTATION FROM LIVING DONORS- SIGNIFICANCE OF PORTAL BLOOD-FLOW

Background Auxiliary liver transplantation has several advantages over standard orthotopic liver transplantation. However, functional compet ition has been reported even in auxiliary partial orthotopic liver tra nsplantation (APOLT), We evaluated herein the interaction in APOLT bet ween the native liver and the graft in terms of portal blood flow and regeneration. The need for diversion of the portal blood flow to the g raft was also assessed. Methods. A total of 15 patients received APOLT from living donors. Portal blood flow to the native liver was preserv ed in 6 patients, and the portal vein to the native liver was preempti vely transected at the time of transplantation in 9 patients. Results. Of the patients with preservation of the portal blood flow to the nat ive liver, two showed inadequate graft portal blood flow just after op eration, and in the other three patients the graft portal blood flow d ecreased or the graft atrophied after deterioration of the graft funct ion. In the patients with preemptive transection of the portal vein to the native liver, optimal graft portal blood flow was obtained, and t he native liver, supplied only by arterial inflow, supported a small-f or-size graft until the graft regenerated. The damage to the native li ver was minimal. Conclusions. Functional competition may occur in APOL T with preservation of the portal blood flow to the native liver, wher eas preemptive transection of the native liver portal vein is a safe p rocedure and effectively prevents the portal steal phenomenon.