Supraceliac aortic clamping during the anhepatic phase of experimental orthotopic liver transplantation

Background: The pig tolerates simultaneous clamping of the liver pedicle an d inferior vena cava poorly, so venovenous bypass has to be used during the anhepatic phase of experimental orthotopic liver transplantation (OLT). Th e aim of this work is to assess whether clamping of the supracoeliac aorta during the anhepatic phase (AP) of experimental OLT in pigs allows transpla ntation in stable hemodynamic conditions. Methods: Fourteen pigs (weight, 16 to 18 kg) received whole liver grafts fr om 14 age-matched donors and were subsequently divided into two groups: gro up I, OLT without venovenous bypass during the AP, group II, OLT with supra coeliac aortic clamping during the AP. Variables analyzed were cardiac outp ut (CO) and related variables, mean systemic arterial pressure (MAP), mixed venous oxygen saturation (S (v) over bar O-2), hepatic artery and portal v ein blood flow, systemic and hepatic O-2 supply and uptake (S(D) over dot o (2), S(V) over dot o(2) H(D) over dot o(2), H(V) over dot o(2), respectivel y), liver enzymes, glucose, creatinine, and electrolytes. Results: In group I, CO, MAP, and S (v) over bar O-2, decreased during the AP (anhepatic) in comparison with baseline (preanhepatic) values (CO, 3.60 +/- 0.74, preanhepatic, v 1.21 +/- 0.25 L x min(-1), anhepatic; P<.05. MAP, 97 +/- 12, preanhepatic, v 43 +/- 17 mm Hg, anhepatic; P<.05. S (v) over b ar O-2, 91.6 +/- 5.6, preanhepatic v 70.0 +/- 12.5%, anhepatic; P <.05), an d S(D) over doto(2)/S(V) over dot o(2) increased by 16% (preanhepatic) to 3 3% (anhepatic; P<.05). In group II, CO decreased during the anhepatic phase by only 21% (3.82 +/- 0.81, preanhepatic, v 3.07 +/- 0.99 L x min(-1) anhe patic; not significant), the MAP increased significantly (100 +/- 8, preanh epatic, v135 +/- 4 mm Hg, anhepatic; P <.05), and S (v) over bar O-2, S(D) over dot o(2), S(V) over dot o(2), and S(D) over dot o(2)/S(V) over dot o(2 ) remained unchanged. After revascularization, none of these variables diff ered significantly between groups, and levels of liver enzymes, glucose, cr eatinine, urea, and electrolytes were similar in both groups, both before a nd after transplantation. Conclusions: Experimental OLT can be carried out in pigs without venovenous bypass, but it leads to severe hemodynamic disturbances. Clamping of the s upraceliac artery during the AP is well tolerated and results in excellent hemodynamic stability, so it may prove to be a useful technique in liver tr ansplantation in animals, such as dogs or pigs, that do not tolerate simult aneous clamping of the liver pedicle and inferior vena cava as well as huma n beings. J Pediatr Surg 34:1374-1377 Copyright (C) 1999 by W.B. Saunders C ompany.