Large-for-size liver transplantation: a flowmetry study in pigs Daniel de Albuquerque Rangel Moreira, MD, Ana Cristina Aoun Tannuri, Professor, Alessandro Rodrigo Belon, Biologist, Maria Cecı´lia Mendonc ¸a Coelho, Biologist, Josiane Oliveira Gonc ¸alves, Biologist, Suellen Serafini, Biologist, Fabiana Roberto Lima, Biologist, Luciana Orsi Agostini, Biologist, Raimundo Renato Guimara ˜ es, Biologist, and Uenis Tannuri, MD* Pediatric Surgery Division, Pediatric Liver Transplantation Unit and Laboratory of Research in Pediatric Surgery (LIM 30), University of Sao Paulo Medical School, Sao Paulo, Brazil article info Article history: Received 16 January 2014 Received in revised form 1 March 2014 Accepted 5 March 2014 Available online xxx Keywords: Ischemiaereperfusion Large-for-size Liver transplantation Blood flow Pig Experimental Pediatric liver transplantation abstract Background: Ischemiaereperfusion injury is partly responsible for morbidity in pediatric liver transplantation. Large-for-size (LFS) liver transplantation has not been fully studied in the pediatric population, and the effects of reperfusion injury may be underestimated. Materials and methods: Thirteen LandraceeLarge white pigs weighing 23 kg (range, 17e38 kg) underwent orthotopic liver transplantation. They were divided into two groups according to the size of the donor body: LFS and control (CTRL). After transplantation, the abdominal cavity of the recipient was kept open and portal venous flow (PVF) was measured after 1 h. The ratio of recipient PVF (PVFr) to donor PVF was used to establish correlations with ischemia and reperfusion parameters. Liver biopsies were taken 1 h after transplantation to assess ischemia and reperfusion and to quantify the gene expression of endothelial nitric oxide synthase, interleukin 6, BAX, and BCL. Results: Recipient weight, total ischemia time, and warm ischemia time were similar be- tween groups. Among hemodynamic and metabolic analyses, pH, central arteriovenous PCO 2 difference, and AST were statistically worse in the LFS group than in the CTRL group. The same was found with endothelial nitric oxide synthase (0.41  0.18 versus 1.56  0.78; P ¼ 0.02) and interleukin 6 (4.66  4.61 versus 16.21  8.25; P ¼ 0.02). In the LFS group, a significant decay in the PVFr was observed in comparison with the CTRL group (0.93  0.08 and 0.52  0.11, respectively; P < 0.001). Conclusions: The implantation of a graft was responsible for poor hemodynamic status of the recipient 1 h after transplantation. Furthermore, the LFS group demonstrated markers of ischemia and reperfusion that were worse when compared with the CTRL group and exhibited a more significant decrease in PVF from donor to recipient. ª 2014 Elsevier Inc. All rights reserved. * Corresponding author. Faculdade de Medicina da Universidade de Sa ˜o Paulo, Avenida Dr Arnaldo 455, 4o andar sala 4109, Sa ˜ o PaulodSP, CEP: 01246-903, Brazil. Tel.: þ55 11 30812943; fax: þ55 11 32556285. E-mail address: uenist@usp.br (U. Tannuri). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.JournalofSurgicalResearch.com journal of surgical research xxx (2014) 1 e8 0022-4804/$ e see front matter ª 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2014.03.018