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Objective To summarize the feasibility and safety of fast perfusion through abdominal aorta and portal vein in combined liver and kidney procurement from organ donation. Methods Clinical data of 43 donors of donation after cardiac death (DCD)undergoing combined liver and kidney procurement in the First People’s Hospital of Foshan from September 201 1 to June 2014 were analyzed retrospectively. Among the 43 donors,15 cases were China DCD donor category Ⅰ (donor after brain death) (C-Ⅰ),1 case was category Ⅱ (donor after cardiac death) (C-Ⅱ)and 27 cases were categoryⅢ(C-Ⅲ). Combined abdominal aorta and portal vein perfusion with fast cannulation were performed. Results The time from abdomen incision to abdominal aorta cannulation was 1.5-2.0 min. Forty-three livers and eighty-six kidneys were procured from 43 donors. The warm ischemia time (WIT)was 0 for C-Ⅰ donors,and was 3-21 min for the other donors (mean:10 min). Two liver grafts were discarded for major injury of the porta hepatis and severe fatty liver respectively. Eighteen kidney grafts were discarded for kidney stones, kidney atrophy, high level of preoperative serum creatinine,severe renal atherosclerosis,renal microvessel thrombosis,multiple renal cyst, kidney traumatic rupture,etc. The total discard rate of donor organs was 16%. Conclusions Fast perfusion through abdominal aorta and portal vein is a simple and safe method in combined procurement liver and kidney from organ donation.
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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.