Experimental auxiliary liver allotransplantation with special reference to biliary duct obstruction and hepatic arterial blood restriction of host liver

Abstract

Auxiliary liver allotransplantation accompanied by various adjuvant procedures was performed in dogs. The auxiliary liver was supplied with all the splanchnic blood in addition to arterial flow. The host liver was damaged by (1) deprivation of portal flow and obstruction of the common bile duct and (2) restriction of hepatic arterial blood flow in some cases. In dogs with deprivation of portal flow and obstruction of the common bile duct, four of thirteen survived forty days or more with a functioning graft. Three animals are still alive at 61, 112, and 135 days and have normal serum bilirubin levels. The bilirubin level was found to be a good index for evaluating a rejection crisis. In this group two dogs showed a reduction in the size of the allograft in the absence of any occlusion of the aortic or arterial supply of the grafts. In dogs with restriction of hepatic arterial blood flow, three of ten dogs survived fifty-four days or more. However, a thrombus developed in the graft portal vein in two dogs and there was marked reduction in size of the allograft. In this series of experiments, atrophy of the graft could be prevented for at least three months; however, one dog, still living at 157 days, is showing gradual diminution in the size of the allograft although the portal vein and hepatic arterial anastomosis of the graft are open. Control dogs with portacaval shunts in which the common bile duct was tied and azathioprine given showed high enzyme levels in the absence of an hepatic allograft. This indicates that elevation of enzymes is not a specific indicator of graft rejection. The combination of technetium 99m radioactive scans and serum bilirubin levels is the best indicator of graft function when the common bile duct of the host is tied.