Estudio hemodinámico, metabólico e histopatológico de un modelo porcino de trasplante auxiliar heterotópico hepático con arterialización portal / A hemodynamic, metabolic and histopathological study of a heterotopic auxiliary swine liver graft with portal vein arterialization

INTRODUCCIÓN: El trasplante auxiliar heterotópico hepático con arterialización de la vena porta (TAHH-AVP) es un modelo poco estudiado a pesar de su potencial terapéutico. El objetivo del estudio es valorar la respuesta hemodinámica y bioquímica durante el implante y analizar la repercusión de la arterialización portal en la funcionalidad y morfología hepática. MÉTODOS: Se realizó un estudio hemodinámico y bioquímico durante el implante auxiliar en un modelo porcino (n = 15 TAHH-AVP). Además, se analizaron las consecuencias de la arterialización portal sobre la arquitectura hepática mediante un estudio ultraestructural. RESULTADOS: La reperfusión del injerto arterializado aumentó la frecuencia cardiaca (FC) respecto a los valores basales (p = 0,004) y a la fase del pinzamiento de la vena cava (p = 0,004) y disminuyó las resistencias vasculares sistémicas respecto a la fase del pinzamiento de la vena cava (p = 0,021). Al final del implante, el gasto cardiaco permaneció elevado (p = 0,001), al igual que la FC respecto a la fase basal (p = 0,002). La presión arterial media disminuyó con el pinzamiento venoso, pero no se vio afectada ni por la reperfusión del injerto ni por el cierre de la piel. Todas las muestras histológicas obtenidas a los 3, 10 y 21 días conservaron su morfología y arquitectura hepáticas. Si bien se observaron algunos focos de necrosis perilobular el día 3 (p = 0,049) y proliferación conectiva perilobular el día 10 (p = 0,007), respecto al hígado nativo. CONCLUSIONES: El trasplante del injerto hepático arterializado descrito minimiza el número de anastomosis vasculares respecto a los modelos previamente publicados, presenta una buena tolerancia hemodinámica y metabólica, y la arterialización portal del injerto no produce cambios significativos en la histología hepática

BACKGROUND: Auxiliary heterotopic liver transplantation with portal vein arterialization (AHLT-PVA) is a model that has been hardly studied, despite its therapeutic potential. METHODS: Hemodynamic and biochemical characterization was carried out during graft implantation, in a pig-to-pig model (n = 15 AHLT-PVA). Furthermore a histopathological study was performed to establish microscopic alterations due to PVA. RESULTS: Reperfusion of the arterialized graft produced an increase in heart rate (HR) vs. baseline (P=.004) and vs. inferior vena cava clamping phase (P=.004); and a decrease in systemic vascular resistance vs. cava clamping phase (P=.021). At the end of implantation, cardiac output remained elevated (P=.001), likewise HR remained increased vs. baseline phase (P=.002). Mean arterial pressure decreased with cava clamping, but was not affected by the reperfusion of the graft, nor the skin closure. The histopathological study at 3, 10, and 21 days post-PVA revealed that functional liver structure was maintained although it is common to find foci of perilobular necrosis on day 3 (P=.049), and perilobular connective tissue proliferation at day 10 (P=.007), vs. native liver. CONCLUSIONS: The described arterialized liver graft model minimizes the number of vascular anastomoses vs. previously described models. It is hemodynamically and metabolically well tolerated and the double arterial vascularization of the graft does not cause significant changes in liver histology

A hemodynamic, metabolic and histopathological study of a heterotopic auxiliary swine liver graft with portal vein arterialization.

BACKGROUND: Auxiliary heterotopic liver transplantation with portal vein arterialization (AHLT-PVA) is a model that has been hardly studied, despite its therapeutic potential. METHODS: Hemodynamic and biochemical characterization was carried out during graft implantation, in a pig-to-pig model (n=15 AHLT-PVA). Furthermore a histopathological study was performed to establish microscopic alterations due to PVA. RESULTS: Reperfusion of the arterialized graft produced an increase in heart rate (HR) vs. baseline (P=.004) and vs. inferior vena cava clamping phase (P=.004); and a decrease in systemic vascular resistance vs. cava clamping phase (P=.021). At the end of implantation, cardiac output remained elevated (P=.001), likewise HR remained increased vs. baseline phase (P=.002). Mean arterial pressure decreased with cava clamping, but was not affected by the reperfusion of the graft, nor the skin closure. The histopathological study at 3, 10, and 21 days post-PVA revealed that functional liver structure was maintained although it is common to find foci of perilobular necrosis on day 3 (P=.049), and perilobular connective tissue proliferation at day 10 (P=.007), vs. native liver. CONCLUSIONS: The described arterialized liver graft model minimizes the number of vascular anastomoses vs. previously described models. It is hemodynamically and metabolically well tolerated and the double arterial vascularization of the graft does not cause significant changes in liver histology.