ABSTRACT
<p><b>OBJECTIVE</b>To study the feasibility of sustaining the viable status of a liver graft in at least 96 h by extracorporeal perfusion using autologous blood.</p><p><b>METHODS</b>Eight extracorporeal porcine liver perfusions using autologous blood were performed, each for 96 h with hepatectomy, cold preservation, cannulation of vessels, and initiation of perfusion with normothermic oxygenated porcine blood. The graft viability was assessed by metabolic, synthetic, hemodynamic, and histologic parameters.</p><p><b>RESULTS</b>After 96 h of normothermic, extracorporeal perfusion using autologous blood, the isolated livers maintained normal physiological levels of pH and electrolytes with sustained hepatic protein synthesis (complement and factor V) throughout the perfusion. Hemodynamic parameters maintained normal physiological ranges. Histological inspection demonstrated good preservation of the liver with a good architectural integrity.</p><p><b>CONCLUSION</b>It is possible to sustain the viable status of a liver graft within 96 h by extracorporeal perfusion using autologous blood.</p>
Subject(s)
Animals , Extracorporeal Circulation , Liver , Liver Transplantation , Organ Preservation , Organ Preservation Solutions , SwineABSTRACT
Objective To study molecular adsorbent recycling system (MARS) in the treatment of patients with acute liver failure waiting for liver transplantation. Methods The effects of MARS artificial liver treatments in 16 cases were reviewed. Results There was a remarkable improvement in clinical symptoms and physical signs after MARS treatment, including significant decrease in prothrombin time, total bile acid, level of alanine aminotransferase, aspartate aminotransferase, creatinine, and blood ammonia (P＜0.05＝;There was no statistical change in NO,TNF-α and IL-10(P＞0.05).Sequential organ failure assessment(SOFA)score decreased from 9.91±1.09 to 6.64±1.76 and Glascow coma score increased from 7.29±2.06 to 13.26±2.14.Fourteen patients were tided over to liver transplantation among them 13 patients survived and were successfully discharged from the hospital. The survival rate was 89.5%.Conclusion MARS is a safe and effective assistant device in bridging acute liver failure patients to liver transplantation.
ABSTRACT
Objective To summerize the experiences of using molecular adsorbent recycling system(MARS) in perioperative period of orthotopic liver transplantation (OLT). Methods The effects of MARS artificial liver treatments in 19 cases were reviewed. Results The levels of serum total bilirubin, BUN, Cr, urine acid and blood ammonia were greatly reduced by using MARS. Fifteen patients were bridged to transplantation, 1 patient was relieved in symptoms of hepatic encephalopathy after MARS treatment, died 2 weeks after leaving hospital, 1 patient died of severe gastro intestinal bleeding before transplantation. The survival rate is 89.5%.Conclusion MARS artificial liver now is a safe and effective assistant device. It can help to gain more chance of undergoing OLT for the patients.
ABSTRACT
The hospital have to arrange discussions about carrying out or giving up life-support treatment such as gastrostomy artificial feeding on critical ill patients with patients themselves or their family members.In this article,we expatiate on the present ethical situation,problems,value assessment,recommendations on this treatment.