Bedeutung der Transplantatrearterialisierung nach auxiliärer partieller orthotoper Lebertransplantation (APOLT) in der Therapie des akuten Leberversagens

Abstract

The aim of this study was to investigate the impact of graft rearterialization after auxiliary partial orthotopic liver transplantation (APOLT) in the treatment of acute liver failure (ALF).

35 Lewis rats were randomly divided into group I (ALF without therapy), group II (ALF treated by APOLT without graft rearterialization) and group III (ALF treated by APOLT with graft rearterialization). In all groups the ALF was induced by a 90% hepatectomy with only 50% of the quadrate lobe remaining. The left liver lobe of the donor rat served as auxiliary graft and was orthotopically implanted with graft rearterialization using an aortic segment (group III). Postoperatively, liver function and survival were observed until the 14th day (Kruskall-Wallis-test, α < 0,05).

Acute liver failure without therapy led to the death of all animals within 2 days. After APOLT, 80% of all animal survived until the 14th day showing significantly decreased liver enzymes. After 14 days the native liver was 5-fold enlarged showing signs of hyperplasia. The lack of graft rearterialization led to increased cholestatic parameters and a secondary biliary fibrosis 2.-4.° corresponding to Ruwart after 14 days. In contrast to this in group III the normal histoarchitecture of the graft could been preserved until the 14th day by graft rearterialization.

In this model the lack of graft rearterialization caused a progressive graft dysfunction. The consequences after APOLT depend on the regeneration and function of the native liver: In case of an insufficient native liver function an immediate retransplantation is required. In case of an advanced native liver regeneration the progressive failure of the auxiliary graft may be compensated by the native liver and, furthermore, avoids functional competition between the graft and the native liver after APOLT.