Surgical technique and clinical outcome of mesenterico left portal shunt after pediatric liver transplantation

50

I149

Poster Sessions SURGICAL

TECHNIQUE

MESENTERICO

AND CLINICAL

OUTCOME

LEFT PORTAL SHUNT AFTER

OF

PEDIATRIC

LIVER TRANSPLANTATION

W.J. Tiefenbacher’, D.C. Broering’, L. Mueller’, R. Ganschow2, K. Helmke3, M. Burdelski2, X. Rogiers I. ‘Dept. Of Hepatobiliary Surgery, University Hospital Eppendod Hamburg, Germany; 2Dept. Of Pediattics, University Hospital Eppendod Hamburg, Germany; ‘Dept.Of Pediattic Radiology, University Hospital Eppendod Hamburg, Germany Background: Portal vein thrombosis after pediatric liver transplantation results in portal hypertension and progressive liver fibrosis. Traditional treatment consists of porto-systemic shunting or sclerotherapy or ligation of esophageal varices. Methods: The prospective study examined 1.5 liver-transplanted children diagnosed with portal hypertension before and after mesenterico-left portal shunting during the past 5 years. Results: 1.5 children were examined: 7 boys and 8 girls, ranging in age from 1 to 13 years (median 5 years) with followed portalveinstenosis. All patients were treated with mesenterico-portal shunting. 11 autologous vena jugularis intema, 2 composite grafts, 2 cryopreserved Vv. Iliacae and one arterial homograft were used. Acturial survival rates at 1, 2 and 4 years after shunting were 100%. Thrombosis of the arterial homograft followed 6 month after shunting. In venous cryopreserved homografts (n=2) a stenosis after lo- and a thrombosis after 15 month occurred. Composite grafts thrombosed after 15. and 58 month. In autologous jugularis interponates no thromboses or stenoses were found. Urinary infection and cholangitis as postoperative complications were seen in two patients. Mean spleen length dropped significantly from 12, 2 to 10, 3 cm after 24 month. The mean central portal vein flow was significantly increased from 10, 3 cm/s to 23, 2 cm/s. Thrombocytes and liver function increased significantly in the first two weeks postoperatively. Shunt patency rate was 100% during an average of 24 month of follow up in autologous interponates. Conclusion: Mesenterico-left portal shunting especially with autologous venous interponates seems to be a good procedure to restore the physiologic portal vein flow after prehepatic block.

I

150

LIVING DONOR

LIVER TRANSPLANTATION

Conclusion: Living donor liver transplantation seems to be an effective and safe alternative for fulminant liver failure patients especially in countries which has a limited number of cadaveric donors.

I 151

THE EFFECT

OF HEPARANASE

ENGRAFTMENT

ON HEPATOCYTE

AFTER INTRASPLENIC

TRANSPLANTATION

CELL

IN THE RATS

V. Tsiperson’, N. Ilan2, G. Shoshany3, 0. Goldshmidt2, I. Vlodavsky2, Y. Baruch’. ‘Liver Unit, Rambam Medical Center And The Bruce Rappaport Faculty Of Medicine, Technion-Israel Institute Of Technology, Ha@, Israel; 2Tumor And Vascular Biology Research Laboratory, The Bruce Rappaport Faculty Of Medicine, Technion-Israel Institute Of Technology, H&z, Israel; ‘Department Of Pediattic Surgery, Rambam Medical Centec H&z, Israel Heparanase (HS) is an enzyme that cleave heparan sulfate proteoglycans and can release various growth factors involved in angiogenesis and other processes that affect tissue integrity and function. Aim: The effect of heparanase on hepatocyte engraftment after intrasplenic cell transplantation in 70% partially hepatectomized rats. Methods: 12/25 of Lewis syngeneic rats, transplanted with 1 x lo7 male hepatocytes pre-incubated with heparanase (50~1). 13/25 rats served as controls. Semi-quantitative analysis of PCR products of SRY region on Ychromosome was performed. Paraffin embedded sections stained for H+E. Results: The presence of transplanted cells within portal radicles was found in 702 HS treated rats and in 203 controls. The number (mean&SD) of positive portal radicles in HS treated rats was 6&10 and 0.46&l in controls (p
FOR FULMINANT

LIVER FAILURE Y. Tokat’,

I 152

SWITCHING

FROM 0- TO 2-HOUR

MONITORING

LOWERS

CICLOSPORIN

DOSE, IMPROVES

KIDNEY FUNCTION

S. Ersoz2, Z. Karasu3, C. Arikan4, D. Nart’, M. Kilic’, M. A. Yerde12, K. Karayalcin2, M. Zeytunlu’, S. Aydogdu4, Y. Yuzer’. ‘General Surgery, Ege University, I&s Turkey; 2General Surgery, Ankara University, Ankara, Turkey; ‘Gastroenterology, Ege University, I&s Turkey; 4Pediattics, Ege University, I&s Turkey; ‘Pathology, Ege University, I&s Turkey

R. ten Hove’, R. Veenendaal’, .I. Ringers2, C.B.H.W. Lamers’, B. van Hock’. ‘GI & Hepatology; 2Surgery, LUMC, Leiden, The Netherlands

Introduction: Acute liver failure due to fulminant hepatitis is a fatal condition with 80% mortality if the patient does not undergo m-gent liver transplantation. In the countries like ours the scarcity of cadaveric allografts has led us to use living donors as an organ som-ce for acute liver failure. Herein, we sought to determine the application, safety and efficacy of living donor liver transplantation in Turkey. Material and Methods: 10 fulminant liver failure patients were transplanted from living donors at two different centers, Ankara and Ege University Hospitals between September 2000 and August 2002. The age of the patients ranged between 5 and 52 years. Etiologies were fulminant hepatitis B in three patients, fulminant hepatitis A in two patients, Wilson’s disease in two patients, mushroom poisoning in one patients, isoniazid intoxication in one patients and was unknown in one patient. 5 of the allografts were left lateral segments, 4 of the allografts were right lobes and one of them was a left lobe without segment one. Results: 8 of 10 patients (80%) survived and currently alive and well with a median 9 months follow-up. None of the survivors had neurological sequela. One of the fulminant hepatitits A patients and the patient transplanted for mushroom poisoning were lost due to sepsis and multiorgan failure. There was not any donor morbidity or mortality.

After orthotopic liver transplantation (OLT) many use emulsified ciclosporin (CICLO) as immunosuppressant. Recent data show blood levels 2 hours after dosing (c-2) better reflect area under the curve (AUC=gold standard) than trough levels (c-0). We investigated creatinin clearance (CRCL), blood pressure (BP), freedom from rejection and relation of c-2 with AUC while switching patients from c-0 to c-2 monitoring. Methods: 22 stable patients more than 6 months after OLT and maintained on a stable dose of CICLO with c-0 between 90 and 150 ug/l collected 24-h urine, while bloodsamples were taken at 0, 1, 2, 3, 4, 6 and 8 hours after dosing to measure ciclosporin (and calculate AUC), creatinin and liver tests, and calculate CRCL. Morning and afternoon BP were measured for l/2 hour. Then in weeks the dose was adjusted to two subsequent c-2 values 600 ug/l & 15%, then the above was repeated. Results: CICLO dose was lowered in 15/22 patients (68%) and unchanged in 7/22 (32%) after conversion. No increase in dose and no rejection occurred. Mean lowering of dose was 65 mg daily (23,6%). Mean increase of CRCL was 6, 2 ml/min (8, 6%). Change in systolic bloodpressure (morning & afternoon) was -3, 13mmHg & +0, 47mmHg (-2, 1% & +0, 3%), change in diastolic bloodpressure (morning & afternoon) was -1,07mmHg & -1, 6mmHg (-1, 2% & -1, 9%) and change in the mean arterial pressure

BUT NOT BLOOD REFLECTS

PRESSURE

CICLOSPORIN

ALTHOUGH

C-2 POORLY

AREA UNDER THE CURVE

F! Langers’,