Zurück

ID: 936 (Conflict of Interest: K)

Doppelligatur von Portalvenen und Lebervenen führt zu einer mit in-situ Split/ALPPS vergleichbaren Hypertrophie – eine präklinische Studie im Schwein

E.Schadde1, S.Breitenstein2, P.Olthof3, M.Hertl1
1Rush University Medical Center, Chicago
2Kantonsspital Winterthur, Winterthur
3Academic Medical Center Amsterdam, Amsterdam

Einleitung

Liver hypertrophy induced by partial portal vein occlusion can be accelerated by adding parenchymal transsection as shown in the “in-situ split/ALPPS procedure”. There is evidence that the mechanism of acceleration is the prevention of neocollaterals between the occluded and the growing part of the liver. A preclinical experimental study in pigs was performed to tests the hypothesis if simultaneous ligation of portal and hepatic veins (PVL HVL) of the liver also prevents the formation neocollaterals and thereby accelerates regeneration as well.

Material und Methoden

A pig model of PVL HVL was established and compared portal vein ligation alone (PVL). The major hepatic veins draining the portal vein deprived lobe were identified with intraoperative ultrasound and ligated using pledgeted trans­parenchymal sutures. Kinetic growth was compared by weighing the lobes after 7 days and  the portal vein system was then studied after 7 days using epoxy casts of the portal circulation. Portal vein flow and portal pressure were measured and Ki-67 staining was used to evaluate the proliferative response.

Ergebnisse

Pigs were randomized to PVL (n=8) and PVL HVL (n=6). PVL HVL was well tolerated, led to mild cytolysis and no necrosis in the portal vein deprived lobe. The portal vein supplied sector increases by 90±22% after PVL HVL compared to 29±18% after PVL (p<0.001). Collaterals to the deportalized liver developed after 7 days in both procedures, but were markedly reduced in PVL HVL. Ki-67 staining at 7 days was comparable. PVL HVL appeared comparable to a previously established pig model of ALPPS in our lab and found to have comparable volume increase.

Schlussfolgerung

This preclinical large animal study shows that simultaneous PVL HVL leads to accelerated hypertrophy comparable to ALPPS. The findings suggest the use of simultaneous PVL HVL accelerates liver regeneration for extended liver re-sections in humans and should now be tested in controlled clinical studies.