Portal vein arterialization promotes liver regeneration after extended partial hepatectomy in a rat model.

Jian Li,Hui Guo,Chaonong Cai,Xiaodong Guan,Peiping Li,Yanhua Zhu ,Lukun Yang ,Li Yue-Chan ,Xialei Liu,Baimeng Zhang

doi:10.7555/jbr.29.20140054

Abstract

In the current study, we sought to establish a novel rat model of portal vein arterialization (PVA) and evaluate its impact on liver regeneration after extended partial hepatectomy (PH). A total of 105 Sprague-Dawley rats were randomly assigned to three groups: 68% hepatectomy (the PH group), portal arterialization after 68% hepatectomy (the PVA group), and right nephrectomy only (the control group). Liver regeneration rate (LRR), 5-bromo-2-deoxyuridine (BrdU) labeling index, and liver functions were assessed on postoperative day 2, 7, 14 and 28. The 28-day survival rates were compared among the three groups. The 28-day survival rates were similar in all groups (P = 0.331), and the anastomotic patency was 100%. The LRR in the PVA group was significantly higher than that of the PH group within postoperative 14 days (P < 0.05). The PVA and PH group had increased serum alanine aminotransferase levels (232 ± 61 U/L and 212 ± 53 U/L, respectively) compared with the control group (101 ± 13 U/L) on postoperative day 2, whereas from postoperative day 7 to day 28 there were no differences among the three groups. Serum albumin values were higher after the PVA procedure within postoperative day 14, which gradually became comparable on postoperative day 28 among the three groups. The peaks of BrdU labeling index appeared on postoperative day 2 in all rats, and the PVA procedure was associated with increased BrdU labeling index from postoperative day 7 to 28. The 28-day survival of the PVA rats was comparable. Our findings demonstrate that the PVA procedure utilizing portal vein trunk-renal artery microvascular reconstruction promotes remnant liver regeneration and confers beneficial effects on maintaining and even optimizing liver function after extended partial hepatectomy in rats.

Highlights

Portal vein arterialization (PVA) was initially introduced to improve encephalopathy and prevent liver failure after portacaval shunt in cirrhotic patients[1] and massive necrosis due to obstruction of the hepatic artery after extended hepatopancreatobiliary surgery[2].Portal vein arterialization combined with portacaval shunt increases blood supply to the liver through the arterialization of the portal stump by an artery[3,4,5,6,7]
In orthotopic and heterotopic liver transplantation, permanent portal vein arterialization was performed in cases with insufficient portal flow to the graft and showed beneficial effects on shortening warm ischemia nThese authors contributed to this study. * Corresponding author: Prof
The liver has a dual blood supply, via the hepatic artery and portal vein, and about 80% is poorly oxygenated venous blood delivered through the portal tract

Summary

Introduction

Portal vein arterialization (PVA) was initially introduced to improve encephalopathy and prevent liver failure after portacaval shunt in cirrhotic patients[1] and massive necrosis due to obstruction of the hepatic artery after extended hepatopancreatobiliary surgery[2]. Portal vein arterialization combined with portacaval shunt increases blood supply to the liver through the arterialization of the portal stump by an artery[3,4,5,6,7]. In the event of an extensive portal vein thrombosis or the absence of a mesenteric vein as an anatomic variant, PVA ensures an adequate blood supply to an orthotopic graft[10,11,12]. Some authors have emphasized a proliferation-promoting influence of PVA on the liver tissue and recommended PVA as a therapeutic option in acute liver failure or after extensive liver resection[13,14,15]

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Results

Conclusion