An alternative surgical technique for caval preservation in liver transplantation

Development of an improved pig model of piggyback liver transplantation with temporary portacaval shunting

AIM: To improve the piggy-back orthotopic liver transplantation (PBOLT) technique in pigs and to enhance the survival rate of pigs after liver transplantation.

METHODS: Pigs were divided into control group and experimental group. The inferior caval vein was separated from the liver of recipients by curettage and aspiration using Peng's multifunctional operative dissector in the control group. Temporary portacaval shunting was added in the experimental group to reduce congestion in the portal system during anhepatic phase.

RESULTS: The PBOLT procedures were performed in eight pairs of pigs in both the control group and experimental group, with a success rate of 87.5% and 100%, respectively. There were significant differences in cold ischemia time (142.8 min ± 7.4 min vs 155.6 min ± 8.3 min, P = 0.006), anhepatic phase duration (25.8 min ± 1.3 min vs 36.3 min ± 1.0 min, P = 0.000), and operation time (264.1 min ± 9.5 min vs 277.3 min ± 8.6 min, P = 0.012) between the two groups though no significant difference was noted in mean bleeding volume (892.5 mL ± 113.9 mL vs 888.8 mL ± 93.7 mL, P = 0.94). The 1-, 2-, 3- and 4-day survival rates were 87.5% and 100%, 25% and 100%, 12.5% and 87.5%, and 0% and 87.5% in the control group and experimental group, respectively. On day 10 after PBOLT, 87.5% of pigs of the experimental group were still alive (P = 0.000).

CONCLUSION: PBOLT with temporary portacaval shunting can maintain hemodynamic stability and relieve congestion of the portal system in pigs during liver transplantation. Control of gastrointestinal congestion is key to the success of liver transplantation and can raise the survival rate of pigs after liver transplantation.