Abstract
(Aim) Small bowel transplantation has proved feasible in humans, but several important questions have yet to be answered. One consideration is the site of venous outflow of the allograft. Portal drainage re-establishes the physiological route of venous outflow, while systemic drainage creates a partial mesocaval shunt.
(Material,Methods) We used canine models. 1. Portacaval shunt (Eck) (n=6) 2. Intestinal autotransplantation with systemic venous outflow (MCA) (n=5) 3. Intestinal autotransplantation with systemic venous outflow plus partial arterialization (spleno.spleno AV fistel) (MCA+A) (n=5). Sham ope (n=5). After four postoperative weeks, we calculated hepatic blood flow, amino acids, NH3, and hepatic ATP. (Result) The metabolic changes observed after MCA did not parallel the changes (hyperammonia and amino acid imbalance) seen after the Eck procedure. Hepatic ATP in MCA was significantly lower than control. However, hepatic ATP in MCA+A was similar to control. (Conclusion) This experimental study showed that partial portal arterialization has beneficial effects on the liver during intestinal autotransplantation with systemic venous outflow.
