| Part OneEstablishment of a New Pig Model for Auxiliary Partial OrthotopicLiver TransplantationOrthotopic liver transplantation is now an accepted treatment for end-stage liver disease, such as liver cirrhosis, congenital atresia of biliary duct and congenital liver metabolic disease. In the middle of 1990s,with the development of reduce-sized liver transplantation, split liver transplantation and partial living liver transplantation, much attention had been paid to auxiliary partial orthotopic liver transplantation (APOLT). Compare to standard orthotopic liver transplantation, APOLT show us the following advantages: First, the remnant native liver can sustain the patient's life when the graft is destroyed by severe rejection or some other events that would otherwise lead to a fatal outcome from hepatic failure. Thus imminent death or the necessity for immediate retransplantation may be obviated. Second, in cases of fulminant hepatic failure, the option of immunosuppressant withdrawal is possible if the remnant native liver recovers sufficiently. Third, in patients with noncirrhotic metabolic liver disease, future gene transfer therapy is still possible in the preserved native liver, moreover, some authors apply auxiliary liver transplantation as a small-for-size graft, where the remnant native liver can support insufficient graft function untilthe graft has regenerated sufficiently.Recently, a new technique of APOLT has been introduced for patients with FHF or metabolic liver disease. APOLT, in which a reduced-size graft orthotopically replaces the resected lobe in the recipient, has the following definite advantages over heterotopic auxiliary liver transplantation (HALT). Both the reduced native liver and the reduced graft can obtain optimal accommodation, and a position close to the right atrium may improve hepatic vencus outflow of the graft.However, function competition and other problem have been reported about APOLT. There are few studies of APOLT using large animal model. We report our attempts to establish a new pig model of APOLT and observed the changes of intraoperative hemodynamic and graft function of the model.Materials and methods Animal selection12 healthy male or female domestic pigs, weighing 22 to 27 kg, were randomly selected to be either a donor (n=6) or recipient(n=6). Prior to surgical procedure, the pig were fasted for 12 hours, but were fed water ad libitum. Surgical procedure.Anesthesia was induced by ketamine intramuscularly with a dose of 20mg in the donor or recipient. After intubation, inhalation anesthesia was maintained by pentothal sodium. For donor operations, we used a midline laparotomy. The infrahepatic inferior vena cava(IVC), common bile duct, portal vein(PV) and hepatic artery(HA) were dissected and exposed. The hepatic artery was kept in continuity with the celiac trunk and abdominal aorta up to the iliac bifurcation. In situ, the whole liver was perfused with 4癈 cold kidney preservation solution via abdomial aorta(l500ml) and portal vein(2000ml). Once perfusion was finished, the harvested graft was removed and immersed in a basin filled with cold kidney preservation solution at 4 *C . During bench surgery a cholecystectomy was performed and the liver splitting was performed with the technique of curettage and aspiration by use of PMOD(Peng's Multifunctional Operative Dissector),the liver was divided along the right side of the middle hepatic vein and the right branches of the PV. The right liver was used as a partial graft and stored at 4癈 in the same solution bath. During the donorpreparation, another surgical team performed the recipient operation. The recipient animal was anesthetized, intubated, and a jugular catheter was placed for blood sampling, intravenous infusion and CVP monitoring. A second catheter was placed in the carotid artery to monitor blood pressure during the procedure. When heparin was intravenously infused with a bolus dose of 2mg/kg, left hepatectomy was performed and the spleen was resected and removed. Before al...
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