Orthotopic Hepatic Transplantation in the Dog

Abstract

Orthotopic hepatic transplantation has become a well-established treatment modality for end-stage liver disease, and research in this field is constantly evolving. Of the 34 canine liver transplants performed in this study, 17 (50%) survived more than 3 days (mean survival time 15 days). Causes of perioperative death included hemmorhage (4), anesthetic complications (3), systemic anaphylaxis (3), portal vein thrombosis (3), hepatic venous outflow block (2), and hepatic artery thrombosis (2). Gentle handling with minimal dissection of the donor liver in situ resulted in a decreased incidence of hepatic venous outflow block. The incidence of biliary leak was similar irrespective of the method of biliary reconstruction, although the incidence of acute cholangitis was 56% in the cholecystoduodenostomy group compared with 0% in the choledochocholedochostomy cohort. Using celiac to common hepatic end-to-side arterial anastomosis with preservation of the gastroduodenal artery, thrombosis of the hepatic artery was encountered in four instances, an incidence similar to previously reported studies where end-to-end hepaticohepatic arterial anastomosis or donor aortic conduit was utilized. The incidence of postoperative intestinal intussusception was reduced from 40 to 0% in those who underwent transmesenteric intestinal plication following implantation of the liver. Among short-term survivors, sepsis was the most frequent noted complication (10), followed by intestinal intussusception (6), rejection (6), and gastrointestinal bleeding (1). Among recipient dogs that survived more than 3 days, rejection was the most common cause of graft loss (5), followed by biliary leak (4) and hepatic artery thrombosis (2).

In the present study we have attempted to describe the donor hepatectomy and orthotopic liver implantation in dogs with emphasis on approach and technical differences. Minimizing liver dissection in the donor and maintaining optimal metabolic and hemodynamic conditions in the recipient are crucial for the prevention of venous outflow block. The end-to-side hepaticohepatic arterial anastomosis is safe, with a complication rate similar to previously described techniques. Choledochocholedochostomy has a lower incidence of septic complications. Transmesenteric plication of the intestine is effective in eliminating postoperative intestinal intussusception.

Key Words:

• Liver transplantation
• canine
• orthotopic