Canine Liver Transplantation Research Articles

Fibrin sealant of the cut surface of partial liver grafts from living donors.

Complete hemostasis and proof against bile leakage on the cut surface of the partial liver graft and the remnant liver of the donor are basic desiderata for a successful outcome in living related liver transplantation (LRLT). This study evaluated the efficacy of fibrin glue sealant on the cut surface of a graft in human living related liver transplantation and canine partial liver transplantation in terms of postoperative complications. From June 1990 to August 1993, a series of 70 LRLTs were performed on children with end-stage liver disease. In harvesting the graft from living donor, hepatic parenchyma was transected by ultrasonic aspirator. Clearly exposed vessels were either ligated or suture ligated. Fibrous connecting tissues of the glissonian branches and tiny vessels were coagulated by a newly devised bipolar electric cautery equipped with saline dripping system. Fibrin sealant was sprayed on the cut surface of the liver graft and the remnant liver of the donor. All donors were discharged from hospital at 10 to 17 (mean = 11.6) days after surgery without any complications that required surgical intervention, and were able to return to normal life. At reperfusion of the graft in the recipients, no blood loss from the cut surface was observed. However, bile oozing on the cut surface was observed in 3 of the 70 cases. No infection or foreign body reactions were observed in the fibrin-sealed cut surface of the graft. Actuarial recipient survival rate was 89% (48/54) in elective cases and 69% (11/16) in emergency cases. In canine transplantation, 16 out of 23 beagles survived for 4 days or longer (longest 20 days).(ABSTRACT TRUNCATED AT 250 WORDS)

Therapeutic effect of 15-deoxyspergualin on acute graft rejection in canine liver transplantation.

Therapeutic effect of 15-deoxyspergualin (DSG) on acute rejection was investigated by examining hepatic functions and histological findings in a model of canine liver transplantation. When acute rejection (defined as an acute rise of hepatic functions) occurred, the recipients were treated with DSG alone or combined with a small amount of methylprednisolone (MP). The recipients in group 1 were administered no basic immunosuppressant, and those in groups 2 and 3 received cyclosporine as the basic drug. The rejections in groups 1 and 2 were treated with DSG combined with MP and those in group 3, with DSG alone. Amelioration or healing of hepatic dysfunction and histological abnormalities as seen in all groups except for one case in group 3. The observations in this study were quite similar to those in renal transplantation. Therefore, DSG therapy is expected to be useful for treating graft rejection even in clinical liver transplantation.

The Assessment of Change in Total Oxygenation by Continuous Monitoring of Mixed Venous Oxygen Saturation during Canine Orthotopic Liver Transplantation

The Assessment of Change in Total Oxygenation by Continuous Monitoring of Mixed Venous Oxygen Saturation during Canine Orthotopic Liver Transplantation

Suprahepatic Vena cava Anastomosis of the Donor Liver to the Recipient Retrohepatic Vena cava in Canine Liver Transplantation

A revised method of the upper caval anastomosis in canine orthotopic liver transplantation is described. It uses the recipient retrohepatic inferior vena cava below the suprahepatic veins for vascular suturing. Ten consecutive operations were performed to assess the feasibility of this method, with special reference to the outflow obstruction at the level of the suprahepatic inferior vena cava. Seven of 10 dogs survived more than 6 days. The cause of death was not related to the outflow obstruction in any instance. Regardless of the duration of survival, free hepatic vein pressures as well as portal vein pressures of all dogs remained in the physiological range even after the skin closures. Based on these observations, we conclude that this approach is safe and reproducible in experimental transplantation of the canine liver.

Initial hepatic metabolic function in canine liver and pancreas cluster transplantation.

In this study, initial hepatic metabolic function was evaluated by determining the arterial ketone body ratio (AKBR) and plasma amino acid concentrations in an experimental orthotopic combined hepatopancreatic transplantation (OHPT), and comparing the same values in orthotopic liver transplantation (OLT). In OHPT, AKBR decreased in the anhepatic phase and recovered to the preoperative value just 1 h after reperfusion. On the other hand, in OLT, the recovery of AKBR took 3 h after reperfusion with a significant difference compared to OHPT (P less than 0.05). Plasma amino acid levels, especially alanine and total free plasma amino acids increased in the anhepatic phase and recovered within 1 h of reperfusion in OHPT. However, they did not recover until 3 h after reperfusion in OLT. This rapid recovery of hepatic metabolic function in OHPT should be attributed to the order of reperfusion in which the reconstruction of arterial blood flow precedes that of portal blood flow. This model is useful for assessing the best way by which the grafted liver can for assessing the best way by which the grafted liver can control the timing, order, rate, and volume of blood that should be released.

Evaluation of initial hepatic allograft function with changes of free plasma amino acids in canine orthotopic liver transplantation

We investigated the correlation between amino acid level and hepatic graft function. Plasma amino acid levels were measured at three time periods during canine orthotopic liver transplantation. During the anhepatic phase, plasma amino acid levels rose except for tryptophan. Cystine and alanine (Ala) increased significantly to 210 ± 28% ( n = 20, mean ± SEM) and 203 ± 11% from preoperative values (100%), respectively. In animals successfully surviving without hepatic insufficiency after transplantation of fresh livers ( n = 7), plasma amino acid levels were restored to preoperative values within 3 hr following reperfusion. On the other hand, in animals that died from hepatic insufficiency within 5 days after grafting of warm ischemically damaged livers ( n = 8), plasma amino acids, especially Ala, phenylalanine, total free plasma amino acids, and aromatic amino acids progressively increased to 216 ± 25, 274 ± 36, 152 ± 15, and 152 ± 15% at 3 hr after reperfusion. These were significantly higher compared to those of the group of animals transplanted with fresh livers ( P < 0.01–0.05). Furthermore, higher values were found in those dogs transplanted with warm ischemically damaged livers surviving for shorter periods. Also in dogs that died from hepatic insufficiency within 8 hr after grafting of livers preserved for 24 hr ( n = 5), amino acid levels were at high values at 3 hr. These results suggest that in animals having good graft function, plasma amino acid levels are restored to preoperative values by 3 hr after reperfusion. In other cases, primary nonfunction should be strongly suspected after liver transplantation.

肝移植無肝期における凝固線溶能の検討

肝移植無肝期における凝固線溶能の検討

Pervenous Hepatic Transplant Angiography Using a New Low Osmolar Contrast Medium An Experimental Study in Dogs

The patency of the vascular anastomoses in a canine liver transplantation model was imaged by serial pervenous angiography using ioxaglate, which is a new ionic low osmolar contrast medium. No premedication or general anesthesia was administered. No major adverse reaction was noted, not even after repeated angiography. Except for the occurrence of one hematoma formation and one paravenous injection, which resolved without leaving sequellae, no local complications occurred. Sufficient information regarding the patency of the hepatic artery anastomosis was obtained in 94% of the angiographic studies, while in 70% the patency of the caval anastomoses could be determined. In addition, portal vein patency was imaged in 21% of the angiograms. Even better visualization results can be expected when combining this method with video subtraction techniques, although patient cooperation or general anesthesia would then be mandatory.

Auxiliary canine liver transplantation from cadaver donors.

Efficient preservation of the donor liver during hepatic transplantation is of crucial importance. Good function of the liver is required immediately after transfer if the patient is to survive liver excision and replacement, because there is no effective means of support in the absence of hepatic function. With auxiliary liver transplantation good function is again required at an early time to reverse the effects of advanced liver failure. Nevertheless, in this situation, the recipient's own liver may retain sufficient function in the early postoperative period to allow the allograft to recover from temporary damage which occurs at the time of transplantation. Laboratory experiments in dogs have shown that at normothermia the ischemic liver becomes unsuitable for transplantation after 20 to 30 minutes.¹If the donor is cooled to 30 C before death and the liver perfused from the time of death with cooled electrolyte solution, this time may be