Influence Of Temporary Portocaval Shunt On Hepatic Function During Orthotopic Piggyback Liver Transplantation

Liver transplantation has revolutionized the treatment of end-stage liver failure caused by liver disease such as hepatitis,liver cirrhosis,hepatic carcinoma, congenital and the metabolic liver abnormalities. Since the first human liver transplantation was executed by Starzl in 1963, many technique types of liver transplantation have been applied for cases, for example, classic orthotopic LT, piggyback LT, split LT and reduced-sized LT.With the development of technique type,the surgical procedure gradually tends to be simple and environment disturbance tends to be stable, also patient s prognosis improved simultaneously. Preservation of the vena cava during OLT has gained wide acceptance, however, benefits of adding a temporary caval-portal shunt (TCPS) to the piggyback technique during the anhepatic phase are still in argument at present.This study aims to determine whether the use of a TCPS improves hepatic function during orthotopic piggyback liver transplantation (PBOLT).Twenty patients were studied prospectively.They were randomly distributed into two groups: patients with a temporary CPS (n =10) and those without a CPS (n =10). In all cases, the piggyback technique was used. Portal vein plasma endotoxin and blood gas analysis data during OLT were evaluated. Pre-portal vein clamped data were similar in both groups.Anhepatic time was lower in the non-CPS group(154.8±21.1 v 170.7±14.9min), whereas plasma endotoxin levels and blood gas disturbance at the end of portal vein clamped were obvious in the non-TCPS grup.The results suggested that some PBOLT without TCPS during anhepatic phase developed remarkable internal environment disturbance within abdomen.The further studies in canine models were as follows.On the basis of anatomy and physiology of canine liver, a revised piggyback orthotopic liver transplantation model was established. The revised model was characteristic with the remained liver lobes playing the role of "diverges" being removed just at the end of anhepatic phase.The remarkable differience compared with other canine LT model was no shunt or bypass being necessary during LT. Additionally,another revised self canine liver...