Liver Pathology after Transplantation of Short-Term Preserved Canine Liver with Euro-Collins or UW Solution / 대한이식학회지

PURPOSE: In living donor partial liver transplantation, the organ cold preservation time is relatively short, thereby, Euro-Collins (EC) solution could be used with comparable result to University of Wisconsin (UW) solution. METHODS: About 70% partial liver was harvested and reimplanted after 3.5 hours of cold preservation with EC or UW solution in same mongrel dog weighing about 25 kg. In 5 cases EC solutions were used, and UW solutions were used in another 5 cases. Blood sample and liver biopsy specimens were taken just before donor hepatectomy, postreperfusion 1 hour, 7 days and 14 days after operation. Serum aspartate aminotransferase (AST), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) were monitored, and morphologic grading of liver injury was performed as Spiegel et al. reported in 1999. RESULTS: Total ischemic time was 4 hours and 27 minutes in average. At 1 hour after reperfusion, there were no significant differences in liver enzyme and morphological score between the UW solution group and the EC group. Survival rate was similar in two groups; 2 dongs were alive at postoperative 7th day, and 1 dog was alive at postoperative 14th day in each group. CONCLUSION: In living donor partial liver transplantation where both operations could be performed simultaneously with relatively short graft preservation time, EC solution could be used with comparable results to UW solution.

Effect of Partial Portal Arterialization on Graft Survival in Experimental Liver Transplantation / 대한이식학회지

PURPOSE: In liver transplantation, low portal perfusion pressure may result in underperfusion of grafts and be the cause of primary nonfunction. Partial arterialization of portal vein could preserve graft perfusion. Up till now, there have been several clinical cases of temporary or permanent portal arterialization in liver transplantation. METHODS: In this study, we designed rat model for evaluating the effect of portal arterialization to improve survival of the under-perfused graft. Partial heterotopic non-regenerative liver transplantation was used with portal inflow only from inferior vena cava, which is known as portal under-perfusing liver transplantation model. Partial portal arterialization was performed by fenestration of the common wall between the IVC and the aorta through venotomy which was made for portacaval anastomosis. RESULTS: Immediate after arterialization, satisfactory macroscopic and duplex ultrasonographic liver perfusion were seen and the arterialized-graft survival was significantly improved to 95% (19/20) vs. 35% (7/20) of nonarterialized grafts. At 2-week after transplantation, the arterialized liver graft was atrophied showed normal gross appearance. The histopathologic examination with light microscope revealed no significant pathologic abnormality. CONCLUSION: Partial portal arteria;ization improved graft-survival of the under-perfusing liver grafts significantly and not affects the histologic hepatic structure adversely.

A Technique for Bile Duct-Duodenal Anastomosis at the Consecutive Rat Liver Transplantation / 대한이식학회지

In rat liver transplantation, the bile duct reconstruction has been consisted of either use of intraductal tubing or direct implantation into the intestine. In our consecutive liver transplant studies, neither of those techniques was properly adoptable because of repeated transplantation of the liver. In order to alleviate or to minimize the unseen problems with the conventional technique, the prospective candidates of the transplant recipients were subjected to bile duct ligation at the distal end three days prior to the transplant in order to obtain a dilated duct. This will enable the operator to readily anastomose the bile duct to the duodenum using continuous suture technique with a 9-0 nylon suture. In this study the partial heterotopic liver transplantation model was used with portal inflow only. Several months after the first transplantation severed bile duct from the duodenal mucosa which can be readily reanastomosed to the next recipient.