Porcine living liver transplantation using a vascular prosthesis to replace the intrahepatic vena cava

Background: This study aimed to determine whether the porcine model could b e adapted to accommodate living donor liver transplantation (LLT). Because the pig hepatic anatomy precludes a standard approach, a study was designed to evaluate the results using a segment of vascular prosthesis to replace the intrahepatic portion of the inferior vena cava (IVC) with establishment of hepatic venous drainage into the graft. Methods: A total of 10 LLT were performed using 20 pigs. After left hepatectomy, the intrahepatic IVC was replaced with a modified aorto-iliac prosthesis, anastomosing the proximal (aortic limb) to the infradiaphragmatic IVC, one distal iliac limb to infra hepatic IVC and the other (after shortening) to establish hepatic venous dr ainage after transplant. Conventional venous bypass was used, and no immuno suppressives were administered. Results: All donors survived the 10-day pos thepatectomy observation period. Eight of the 10 transplanted pigs survived at least 2 days (mean 7.6 days; range 3-13 days). No evidence of caval gra ft thrombosis was observed. Conclusions: Replacement of the recipient intra hepatic IVC by a vascular prosthesis allows to overcome the major technical obstacle which has limited the use of pigs in LLT.