Asanguinous hypothermic liver perfusion in dogs

Abstract

An original, simplified, and consistently reproducible technique for isolation and perfusion of the canine liver in vivo was developed after experimentation upon over 60 dogs. The hepatic outflow was isolated by use of an intracaval shunt and creation of a chamber containing pure hepatic effluent surrounding the shunt. This is accomplished through an abdominal approach. The need for heparinization and extracorporeal circulation has been eliminated. The procedure is free from systemic admixture as assessed by BSP determination. Regional hepatic hypothermia is maintained at 14°C. to 16°C. without systemic hypothermia. Contamination with blood is reduced to less than 1 cc. per minute (hematocrit of the effluent is consistently less than 1%) after the washout. Hepatic outflow block was not observed either during or after perfusion. Hypotension did not follow revascularization in perfusions lasting up to 90 minutes. Mild hypotension followed perfusions up to 180 minutes but was spontaneously reversed without the need for vasopressors. Eleven of 15 dogs survived after being perfused between 60 and 90 minutes. Three of 6 dogs survived after being perfused 120 minutes. Death could be attributed to hepatic failure in the dogs perfused for longer periods of time.