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Presenter: Flavio, Galvao, Sao Paulo, Brazil
Authors: Bernardo Ketzer, Rodrigo Vincenzi, Ana Maria Coelho, Kátia Leite , Flavio Galvao, Luiz D'Albuquerque, Ruy Cruz
Bernardo Ketzer1, Rodrigo Vincenzi2, Ana Maria M. Coelho1, Kátia R. Leite 2, Flavio H. Galvao1, Luiz C. D'Albuquerque1, Ruy J. Cruz3.
1Visceral Transplantation, University of Sao Paulo, Sao Paulo, Brazil; 2Visceral Transplantation, Hospital Sirio-Libanes, Sao Paulo, Brazil; 3Intestinal Rehabilitation and Transplant Center, Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
Background: Liver-sparing modified multivisceral transplantation (MMVTx) is a valid therapeutic option for patients with diffuse gastrointestinal disorders and preserved hepatic function. During evisceration, portal vein blood flow to the native liver is interrupted until allograft reperfusion. In this setting, efforts must be made to minimize the period of hepatic deportalization. We herein examined the effects of prolonged portal vein blood flow interruption on liver oxygenation and metabolism during multivisceral evisceration.
Methods: Eight pigs (20.1+/-0.5 kg) were subjected to an en bloc resection of abdominal organs including; stomach, duodenum, pancreas, spleen, small bowel, and colon. Hepatic blood flow was maintained exclusively by the hepatic artery (HA; arrow) for 180 min (Figure A). Systemic hemodynamics were evaluated through a Swan-Ganz catheter, ultrasonic flowprobes (HA and renal artery), hepatic and portal vein catheters, and arterial lines (Figure B). Systemic and regional O2-derived variables, glucose and lactate metabolism, liver function tests, fibrinogen, Factor V, malondialdehyde (MDA) content, and mitochondrial respiration were analyzed throughout the experiment. Tissue samples were collected at baseline and at the end of the experiment for histopathological analysis including apoptosis detection using TUNEL methods.
Results: Abdominal exenteration was not associated with significant systemic hemodynamic changes, besides a mildly reduction on cardiac output at the end of the experiment (3.4±0.5 to 2.6±0.3 l/min). Despite steady and substantial increase of the HA blood flow (288±60 to 561±231 ml/min), interruption of PV blood flow was associated with a marked reduction of hepatic oxygen delivery (168±41 to 75±39 l/min), with a concomitant increase of lactate levels (2.9±1.3 to 4.2±2.1 mmol/l). No significant changes of liver function tests, Factor V levels, and mitochondrial respiration were observed three hours after evisceration. All the animals were alive at the end of experiment.
Conclusion: Despite a long period of interruption of portal vein blood flow during multivisceral evisceration the compensatory increase on hepatic artery blood flow (i.e. hepatic artery buffer response) prevents further liver injury.
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