Abstract
BackgroundLiver transplantation in presence of diffuse portal vein thrombosis is possible by using caval blood as portal inflow, through cavo-portal transposition. However, clinical results are heterogeneous and experimental studies are needed, but similar hemodynamic conditions are difficult to obtain, especially in small animals. Herein we describe a new simple model of cavo-portal transposition in rat.MethodsSpontaneous porto-systemic shunts are induced by subcutaneous transposition of the spleen. The presence of porto-caval shunts through the spleen permits the interruption of the main portal vein without splanchnic hemodynamic consequences. Cavo-portal transposition is achieved by anastomosing the inferior vena cava and the main portal vein after division of the pancreatic-duodenal vein.ResultsSelective angiography revealed total splanchnic blood diversion to the systemic venous circulation through the neoformed collaterals; macroscopical examination showed the absence of any signs of acute portal hypertension with normal liver and gut appearance.ConclusionThis model of cavoportal transposition is simple, effective and it simulates the clinical hemodynamic condition since the porto-systemic shunts induced by splenic subcutaneous transposition correspond to the physiological inframesocolic collaterals during chronic portal thrombosis in man.
Highlights
Liver transplantation in presence of diffuse portal vein thrombosis is possible by using caval blood as portal inflow, through cavo-portal transposition
Thrombosis of the portal vein has been a formidable challenge in liver transplantation and it was historically considered an absolute contraindication [1]
Patients with chronic thrombosis without portal hypertension are the best candidates due to the presence of wide spontaneous porto-systemic shunts that completely supply the splancnic vein drainage [7]. The results of these techniques are still heterogeneous and further experimental and clinical studies are needed to clarify the role of spontaneous porto-systemic shunt on liver function after cavoportal transposition [8]
Summary
Liver transplantation in presence of diffuse portal vein thrombosis is possible by using caval blood as portal inflow, through cavo-portal transposition. Patients with chronic thrombosis without portal hypertension are the best candidates due to the presence of wide spontaneous porto-systemic shunts that completely supply the splancnic vein drainage [7]. The results of these techniques are still heterogeneous and further experimental and clinical studies are needed to clarify the role of spontaneous porto-systemic shunt on liver function after cavoportal transposition [8]. Similar hemodynamic conditions are difficult to obtain, especially in small animals [9]; we described a new simple model of cavoportal transposition in rat with previously induced porto-systemic shunts BMC Surgery 2007, 7:18 http://www.biomedcentral.com/1471-2482/7/18 been obtained by end-to-end or end-to-side porto-caval anastomosis or by reno-portal anastomosis [4,5,6].
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