Veno-venous bypass in Orthotopic Liver Transplantation for children: Experimental study in pigs and dogs

• Project/Area Number: 62480274
• Research Category: Grant-in-Aid for General Scientific Research (B)
• Allocation Type: Single-year Grants
• Research Field: General surgery
• Research Institution: KEIO UNIVERSITY
• Principal Investigator: KATSUMATA Keizou Keio University school of medicine, professor, 医学部, 教授 (30051105)
• Co-Investigator(Kenkyū-buntansha): HOSHINO Ken Keio University school of medicine, assistant, 医学部, 助手 (70190197) ; HARA Shinichi Keio University school of medicine, assistant, 医学部, 助手 (40180997) ; HIROBE Seiichi Keio University school of medicine, assistant, 医学部, 助手 (20181224) ; MATSUFUJI Akira Keio University school of medicine, assistant, 医学部, 助手 (80190502) ; YOKOYAMA Jotaro Keio University school of medicine, associated professor, 医学部, 講師 (80051407)
• Project Period (FY): 1987 – 1988
• Project Status: Completed (Fiscal Year 1988)
• Budget Amount: ¥4,900,000 (Direct Cost: ¥4,900,000); Fiscal Year 1988: ¥400,000 (Direct Cost: ¥400,000); Fiscal Year 1987: ¥4,500,000 (Direct Cost: ¥4,500,000)
• Keywords: Orthotopic liver transplantation / Hemodynamic change in anhepatic phase / Veno-venous shunt / Bio-pump / バイパス至適流量 / 門脈再循環時高カリウム血症 / primary graft ftilure / Beno-venous shunt / Bio-punp:バイパス至摘流量 / 門脈循環時高カリウム血症 / Primary graft failure / イヌ同種同所性肝移植 / VenoーVenous shunt / Biopump

Research Abstract

Experiment I: Effect of the flow volume of the porto-systemic bypass on the hemodynamic change of the recipient in anhepatic phase was evaluated in five pigs (15kg of approximate body weight). The pig liver was isolated and the systemic and splanchnic venous flow was shunted to the external jugular vein using centrifugal pump (Bio-pump^<TM>). Mean arterial pressure (MAP) elevated by increasing flow volume of the bypass, and MAP was well maintained over 100mmHg, which was not significantly different from a pre-op. value, when a pump flow was given over 20ml/kg. Systemic Venous Resistance (SVR) markedly dropped when the pump flow increased to 20ml/kg.
Experimental II: Donor livers were perfused in situ via the portal vein and hepatic artery with cold lactate ringer solution. They were kept in the same solution at 4C for one hour, and following experiments were carried out to evaluate the cold ischemic damage during preservation using potasium level as a marker: (a) Effluents from the hepa tic vein of the isolated liver were sampled. (b) Initial perfusate right after reconstruction of the portal vein was obtained through infrahepatic IVC with supra hepatic IVC clamped. The concentration of K+ was significantly lowered by washing out the donor liver with an amount of 10-15ml/kg of solutions.
Experiment III: Twenty seven orthotopic liver transplantation were performed in dogs (n=18) and pigs (n=9) using a centrifugal pump with 20ml/kg of a flow volume and a wash out technique with 10-15 ml/kg of cold lactate ringer solution before portal reconstruction. S-GOT level was higher In a group of dogs which could go on their spontaneous breathing for more than 10 hours after operation than that was less than 10 hours. in a pig which tolerated transplantation and survived for two weeks, initial change of the levels of S-GOT, prothrombin time, and hepaplastin test in twelve hours after experiment turned to recover in next six hours. this might suggest that 12 to 18 hours after transplantation could be a critical period for possible primary graft failure.