Brettschneider, L

Kolff, J

Martin, AJ

Smith, GV

Starzl, TE

Taylor, P

PubMed

Name not available

An evaluation of perfusion constituents in liver preservation

D-Scholarship@Pitt

AN EVALUATION OF PERFUSION CONSTITUENTS IN LIVER PRESERVATION LAWRENCE BRETTSCHNEIDER, M.D., JACOB KOLFF, M.D., GEORGE V. SMITH, M.D., ALFRED J. MARTIN, M.D., PAUL TAYLOR, AND THOMAS E. STARZL, M.D., F.A.C.S. A TECHNIQUE has been presented (I) which, if used in the optimum way, always permitted successful preservation of dog livers for 8 to 9.5 hr. and often for as long as 24 hr. The test system involved orthotopic transplantation to mongrel recipients. The best preservation tech-nique was with a combination of hypothermia (40 C.), hyperbaric oxygenation (40 pounds per square inch gauge), and perfusion (6 ml./gm. tissue/hour.) with diluted blood. Exactly the same method has been used in the successful conservation of human livers which were transplanted orthotopically after a postmortem interval of more than 7 hr. (2, 3). However, the need for homologous fresh blood in the system was an inconvenience. Therefore, perfusates were evalu-ated in the present study w.hich contained either plasma instead of whole blood or hemoglobin which was added to a balanced electro-lyte solution containing low molecular weight dextran (LMDX). METHODS The decompression schedule, temperatures, flow rates, and other details of procedure were identical to those used with the best homol-From the Department of Surgery, University of Colorado School of Medicine and Veterans Administration Hospital, Denver. Supported by U. S. Public Health Service grants AM-06344, HE-07735, AM-07772, AI·04152, FR-00051, FR-00069, AM-12148, and AI-AM-08898. ogous blood technique (1) Immunosuppression with azathioprine, prednisone, and heterologous antilymphocyte globulin (ALG) was the same as in the earlier studies. Only the perfusate constituents were changed. Three different solutions were tested. Group A: Hemoglobin solutions were prepared by Folkman's mod-ification of Pennell's technique (4). A hemoglobin concentration of 5 to 7 gm. % was obtained by adding a balanced electrolyte solution (containing 5 gm.% LMDX) in a one part electrolyte to three parts hemoglobin solution volume ratio. Group B: Unaltered pooled fresh plasma was added to an equal volume of balanced electrolyte solution containing 5 gm. % LMDX. Group C: Pooled fresh plasma was frozen for 12 hr. or longer. The lipoprotein flocculate was then removed as described by Belzer (5) and the plasma used in undiluted form. RESULTS Group A: The five livers which were preserved for 8 to 10.5 hr. had an average weight loss of -0.7% (range +5.4% to -7.9%). Four of the dogs which received these organs as orthotopic homografts died within 24 hr. of hemorrhage and hepatic insufficiency. The fifth dog died on the fifth postoperative day of intussusception; he ne' . had good hepatic function. Group B: The organs lost an average of -0.9% of their weight (range +12.2% to -6.6%) during preservation of 9.5 to 10.45 hr. Two of the recipients died on the first day, one dog of uncontrolled hemorrhage and the other with massive ascites and atelectasis. An-other dog died after two days of acute hepatic insufficiency and hem-orrhage. Both the 19 day survivors had good early function. One dog later developed fatal homograft rejection; the second died from a perforated duodenal ulcer despite excellent hepatic function. Group C: Preservation was 9.25 to 11 hr. There was an average weight loss of -904% (range -5.4% to -16.3%). All five recipients died within 24 hr. with hemorrhage and ascites which were thought to be expressions of acute hepatic insufficiency. CONCLUSION Experiments have been done reaffirming the effectiveness of the homologous blood perfusion technique in 8 to 12 hr. preservations. None of the deviations in the present study worked as well. This was a particularly disappointing finding since the perfusate used in Group C was the same as that shown by Belzer to be of value for kidney stor-age (5). However, other aspects of the method were different than that of Belzer who has not used hyperbaric oxygenation. In addition, his system contains a membrane oxygenator and employs a pump which provides a more physiologic pulse contour. REFERENCES 1. BRETTSCHNEIDER, L., DALOZE, P.M., HUGUET, C., GROTH, C.G., KASHIWAGI, N., HUTCHISON, D.E., and STARZL, T.E. Successful orthotopic transplantation of liver homografts after 8-25 hours preservation. Surgical Forum. Chicago: American Col· lege of Surgeons. 1967, Vol. XVIII, p. 376. 2. BRETISCHNEIDER, L., GROTH, C.G., and STARZL, T.E. Experimental and clinical preservation of orthotopic liver homografts. In Organ Perfusion and Preservation. New York: Appleton, Century and Crofts, (in press). 3. STARZL, T.E., GROTH, C.G., BRETISCHNEIDER, L., PENN,!., FULGINITI, V.A., MOON, ].B., BLANCHARD, H., and PORTER, K.A. Orthotopic homotransplantation of the human liver. Ann. Surg., 1968 (in press). 4. FOLKMAN, ]., LONG, D.M., JR., and BECKMAN, F.F. Growth and metastasis of tumor in organ culture. Cancer, 1963, 16:453. 5. BELZER, F.O., ASHBY, B.S., HUANG, ].S., and DUNPHY, ].E. The etiology of ris· ing perfusion pressure during isolated organ perfusion. Ann. Surg., 1968 (in press). 

An evaluation of perfusion constituents in liver preservation.

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An evaluation of perfusion constituents in liver preservation.

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