YOKOI Hajime Mie University, Faculty of Medicine, University Hospital, Assistant Professor, 医学部附属病院, 講師 (60174843)
NOGUCHI Takashi Mie University, Faculty of Medicine, Associate Professor, 医学部, 助教授 (40144258)
KAWARADA Yoshifumi Mie University, College of Medical Sciences, Professor, 医療技術短期大学部, 教授 (40024814)
|Budget Amount *help
¥7,000,000 (Direct Cost : ¥7,000,000)
Fiscal Year 1991 : ¥1,000,000 (Direct Cost : ¥1,000,000)
Fiscal Year 1990 : ¥900,000 (Direct Cost : ¥900,000)
Fiscal Year 1989 : ¥5,100,000 (Direct Cost : ¥5,100,000)
Multiple organs are in irreversible conditions in many patients with digestive disorders, and total abdominal organ transplantation may be required for radical treatment. Especially, simultaneous transplantation of the liver and the pancreas, which are the centers of metabolism, is indicated in some cases. This study was designed to establish the surgical procedure of simultaneous whole transplantation of liver and pancreas to closely evaluate intraoperative and postoperative management, as well as to investigate the pathology of the liver function and pancreatic endocrine functions and immunological phenomena such as rejection from the viewpoint of organ interrelations. Comparisons of adult mongrel dogs received simultaneous liver. and pancreas transplantation, liver transplantation alone, and pancreaticoduodenal transplantation yielded the following results.
(1) Problems with operative procedure : The donor graft was best perfused with Ringer's solution at 4ﾟC at a rate of 80-100ml/kg
/hour. In operation of the recipient, reperfusion was started most successfully in the artery, and low-molecular-weight dextran infusion at. 20-30ml/kg/hour was appropriate for intraoperative and postoperative management.
(2) 2-day and 7-day survival rates : No immunosuppressants were administered in any group. The 2-day and 7-day survival rates were 50% and 38%, respectively, in the simultaneous liver and pancreas transplantation group (n=8), 67% and 50%, respectively, in the liver transplantation group (n=6), and 80% and 60% respectively, in the pancreas transplantation group (n=5). Rejection. was observed 5 or more days after transplantation in all groups.
(3) Liver graft function and changes in energy metabolism The general liver function returned to the preoperative level 1-5 days after transplantation in all groups, and no significant difference was observed between the animals that died and those that survived. However, ketone body ratio in the arterial blood and amino acid concentrations in the venous blood 3 hours after reperfusion showed close correlations with the outcome. Moreover, the resting energy consumption determined by indirect calorimetry 30 minutes after reperfusion accurately reflected the outcome. The respiratory quotient was significantly higher in the simultaneous liver and pancreas transplantation group than in the liver transplantation or pancreas transplantation group and showed. a correlation with insulin secretion.
(4) Carbohydrate metabolism and pancreatic islets hormones : Characteristic changes after simultaneous liver and pancreas transplantation were observed immediately after reperfusion and 5 or more days after operation, when rejection developed. The former changes were dependent on the degree of recovery in the viability of the graft pancreas function and were related with a decrease in pancreatic islets hormones secretion and liver injury. The latter changes were abnormalities in pancreatic endocrine function dependent on the severity of rejection, and were more notable after transplantation of the pancreas alone. Less