Role of Arterial Blood Supply in Orthotopic Whole and Partial Liver Transplantaion in the Rat

Aims: The hepatic artery (HA) thrombosis is a serious complication after liver transplantation (LT). In the present study, role of blood supply from HA to the grafted liver was experimentally investigated. Methods: Rats were grouped into 4: Group I-whole LT without HA reconstruction, Group II-partial (30%) LT without HA reconstruction, Group III - whole LT with HA reconstruction, and Group IV - partial (30%) LT with HA reconstruction. Results: In Group III, posttransplant elevation of serum levels of GOT and total bilirubin was minimal. Those levels in Groups I and II were significantly higher, compared to those in Groups III and IV. Dilatation of the bile duct and bile stasis were evident in 60% and 71% of rats in Group I and II, respectively. In Group II, histological examination demonstrated that proliferation of bile duct around the portal triad was prominent at early period after LT. Those findings were mild and there was no histological evidence of destruction of vascular and bile duct structures in Groups III and IV. Conclusion: These findings were suggestive that arterial blood flow to the grafted liver played an important role to feed nutrients to the biliary tree. In order to prevent damage in the biliary tract, successful reconstruction of HA is essential in LT

Effect of Polyethylene Glycol Conjugated Superoxide Dismutase on Hepatic Ischemia/Reperfusion Injury in Rats

Superroxide anion radical (02-) has been suggested as a causative factor of ischemia/reperfusion injury to the liver. Superxide dismutase (SOD)is a specific scavenger for 02, but its elimination half life in the blood is about five min. Polyethylene glycol conjugated SOD (PEG-SOD) has a chracteristics of long half life (14hr) in the circulating blood and low immunogenicity. In the present study, we compared the effect of PEG-SOD to conventional SOD in protecting the ischemia/reperfusion injury to the liver. In rats with an occluded inflow against 70% of the liver for 30min followed by 30min reperfusion, elevations of serum aspartate aminotransferase and alanine aminotransferase,and lipid peroxide concentrations in the liver were not significantly inhibited by intravenous administration of PEG-SOD, compared to those treated with conventional SOD. These results indicate that sustained presence of radical scavenger activity in the circulating blood has no more beneficial effects on hepatic ischemia/reperfusion injury than its temporary presence when reperfusion begins

Percutaneous Transhepatic Drainage of Pyogenic Liver Abscess under Ultrasonography Guidance

Nineteen patients with liver abscess were treated in our department over a period of 14 years. The cause of the liver abscess was biliary disease in 13 of the 19 or 68%, and 8 of these 13 patients had undergone surgical procedures. The 13 patients with liver abscess received both percutaneous transhepatic abscess drainage (PTAD) under ultrasonography (US) guidance and antibiotics. The remaining 6 were treated with antibiotics alone. Among the 13 cases treated with PTAD, 11(84%) were cured in an average of 22 hospital days. One case (8%) with liver abscess caused by tuberculosis was unchanged and 1 (8%) died of hepatic failure due to liver cirrhosis. There were no complications related to PTAD, but the mortality rate among patients receiving antibiotics only was 33%. PTAD is the most advisable treatment for liver abscess and should be followed by appropriate supplemental management of the original conditions. Moreover, amputation of the distal bile duct is an indispensable part of bile diversion procedures because it prevents reflex cholangitis which may cause future liver abscesses