Canine Liver Transplantation without in Situ Portal Perfusion

Lee, Kuhn Uk; Ha, Jong Won; Suh, Kyung Suk; Jung, Sung Eun; Yun, Ik Jin; Kim, Jong Jae; Kim, Sang Joon

Abstract

BACKGROUND: Many liver transplant surgeons think that portal vein cold perfusion is essential during liver procurement. However, it may limit the perfusion to the pancreas and small intestine and may lengthen the procedure. If visceral arteries are not ligated, perfusates passing the spleen and the small intestine can eventually cool the liver. Aorta only perfusion is rapid and easy and can be performed with the better perfusion of the pancreas and small intestine than with conventional perfusion. However, it may delay the cooling of the liver. The purpose of this study was to evaluate the feasibility of aorta only perfusion compared with conventional perfusion as an alternative method for multiorgan procurement.
METHODS
Male mongrel dogs of 16-18 kg were used. In the control group (n=5), standard multiorgan procurement method, including portal vein perfusion, was performed. In experimental group (n=4), aorta only perfusion without superior mesenteric artery ligation was performed. An isotonic citrate solution was used as a perfusate. In the control group, a total amount of 800 to 1000 ml of the perfusate was used to each portal vein and aorta perfusion. In the experimental group, 1500 to 2000 ml of the perfusate were infused only to aorta. After donor liver procurement, 200 to 300 ml of the perfusate was added to the portal vein and the hepatic artery at a ratio of 8:2. Core temperature changes of the liver during perfusion with preservation solution were checked at 5-second intervals. Standard orthotopic liver transplantation was performed. Wedge liver biopsies were performed after procurement and 1 hour after reperfusion. A liver function test was performed, and the hematologic features, and the coagulation profiles were measured preoperatively and one hour after reperfusion. In histologic examination, injuries of hepatic vessel endothelia and hepatocytes were evaluated semiquantitatively under light microscopic and electron microscopic exams.
RESULTS
A comparion of the two groups showed no differences in operation time, anhepatic time, and ischemic time. The values of the leukocyte count, the hemoglobin, hematocrit, the prothrombin time,the partial thromboplastin time, the total protein/albumin, bilirubin, ALT/AST and alkaline phosphatase were not different between two groups. Falling of liver core temperature during perfusion was slightly delayed in experimental group. However the delayed time was less than 2 minutes until to reach the temperature of 10oC. The histological grading scores of hepatocytes and endothelial damage determined from light microscopic and electron microscopic examinations were not different from each other.
CONCLUSIONS
There was no difference between aorta only perfusion group and portal vein perfusion group, including the severity of liver damages. Therefore, liver procurement without in situ portal perfusion may be a reasonable alternative to combined portal and aorta perfusion on the background of rapid procurement and benefit to the pancreas and small intestine procurement.