Successful treatment by simultaneous hepatic venoplasty and cavoplasty for Budd-Chiari syndrome with obstruction of retrohepatic inferior vena cava.

BACKGROUND: Various surgical procedures for treating chronic Budd-Chiari syndrome have been established, but none are adequate because of the variation in underlying pathologic vascular changes. METHODS: This article presents a 32-year-old patient with a 5 cm long segment of obstruction of the retrohepatic inferior vena cava involving the main hepatic veins with severe portal hypertension. RESULTS: After five unsuccessful attempts at percutaneous transluminal angioplasty, simultaneous hepatic venoplasty was conducted with the saphenous vein patch and retrohepatic inferior venacavoplasty by the expanded polytetrafluoroethylene patch with a 3 cm long cuff interposition for suprahepatic reconstruction of the inferior vena cava. Hypothermic preserved liver perfusion after vascular isolation and femoroportoaxillary venovenous bypass with a centrifugal blood pump throughout the anhepatic stage ensured safe operation on the liver and maintained hemodynamics. Early postoperative anticoagulant is recommended. CONCLUSIONS: An uneventful postoperative course and a 10-month follow-up showing excellent condition indicated this one-stage simultaneous patch hepatic venoplasty and cavoplasty to be adequate for appropriate correction very of complex obstructive vascular lesions in Budd-Chiari syndrome.

A comparison study of rat pancreas preservation using perfluorochemical and fluorocarbon-emulsion as preservation medium.

We reported previously the successful 72-hour cold rat pancreas preservation by using Perfluorochemical (PFC). The present study is to determine whether Fluorocarbon (FC) emulsion is as effective as PFC for long-term rat pancreas preservation. Lewis rat pancreases were stored in FC emulsion (4 degrees C) saturated by continuous supply of oxygen:carbon dioxide (95%:5%) (Group I) or by 100% pure nitrogen (Group II), or in PFC (4 degrees C) saturated by continuous supply of oxygen:carbon dioxide (95%:5%) (Group III) or nitrogen (Group IV) for 24 h and 48 h. Heterotopic pancreas transplantation into isogeneic diabetic rats were performed following preservation. Functional graft success rates following 24 h and 48 h cold storage were 71% (5/7) and 0% (0/5) in Group I, 71% (5/7) and 0% (0/5) in Group II, 100% (5/5) and 80% (4/5) in Group III, and 80% (4/5) and 0% (0/5) in Group IV, respectively. These results showed that, as an artificial blood substitute, the PFC with simple oxygen bubbling for 48-hour preservation of rat pancreas was much effective than FC emulsion, but not effective when saturated with nitrogen. We concluded that the PFC with saturated oxygen can obtain long-term successful preservation of rat pancreas. The direct oxygenation of the graft tissues is thought to play an important role in organ preservation.

Prolonged rat pancreas preservation using a solution with the combination of histidine and lactobionate.

A newly formulated solution consisting of lactobionate with or without histidine was tested in the preservation of the rat pancreas. Adult male Lewis rats weighing 120-250 g were used as donors and recipients. Fifty-four rat pancreas transplants were performed to investigate the effectiveness of this test solution and to compare it with the standard University of Wisconsin (UW) solution. The final osmolarity of the new test solution was 290-320 mosmol/l. This solution had a higher sodium content and lower potassium content (Na: 110 mEq/l, K: 50 mEq/l). Adenosine, insulin, hydroxyethyl starch and dexamethasone, which are components of the UW solution, were not present in this test solution. Histidine was used as a buffer. Rat pancreases were stored at 4 degrees C in either standard UW solution, or high-Na+-histidine solution, or high-Na+-lactobionate solution for 48 h and 72 h prior to heterotopic transplantation into rats with streptozotocin-induced diabetes mellitus. Functional success rates for rats receiving pancreases that had been preserved in high-Na+-histidine and in high-Na+-lactobionate solutions at 4 degrees C were 100% (5/5) and 100% (7/7) after 48 h preservation, and 50% (4/8) and 14% (1/7) after 72 h preservation, respectively. By contrast, standard UW solution gave only a 44% (4/9) success rate after 48 h preservation and a 0% (0/8) success rate after 72 h preservation. These results demonstrated that the high-Na+-histidine solution was superior to standard UW solution for rat pancreas preservation. This was probably due to the buffer, histidine, which prevented the acidosis of ischemic tissue during the period of preservation.

The results of transplant livers from selected non-heart-beating cadaver donors.

The clinical experience following transplantation of livers obtained from non-heart-beating cadaver donors (NHBD) with the use of core cooling method is presented here. Six livers procured from such cadavers were transplanted into 6 recipients with hepatoma involving right and left lobes but without distant metastases. The first liver subjected to 75 minutes of warm ischemia had insufficient function after transplantation. The recipient died of graft failure 54 days later. The other 5 livers with 32 to 45 minutes of warm ischemia had a good or excellent immediate function. These 5 recipients died of tumor recurrence, acute rejection or septicemia 131 to 261 days after transplantation. The utilization of selected NHBD is suggested by our practice as a possible approach to help alleviate the acute organ shortage in the areas where heart-beating cadaver donors of brain death are not available.

Study of portal arterialization with auxiliary liver in rats.

The effect of portal arterialization was examined in 20 heterotopic auxiliary rat livers. Portal blood was supplied from recipient iliac artery (0.58 mm in diameter) connected to the donor portal vein using the cuff technique. Portal hypertension caused by arterial blood pressure resulted in the immediate operative death by bleeding in four of the rats (20%) from the spontaneous rupture of the graft capsule. Severe graft congestion was noticed at autopsy 3-14 days after transplantation in 13 rats. Massive portal and sinusoidal congestion and focal hemorrhagic necrosis were confirmed by pathological examination. The results of our study demonstrate that the portal arterialization used in the auxiliary rat liver transplantation would not be applicable unless the optimal hemodynamic condition is warranted.

Total pancreaticoduodenal homotransplantation in dogs immunosuppressed with cyclosporine and steroids.

Pancreaticoduodenal transplantation was performed with cyclosporine and steroid immunosuppressive therapy in 10 mongrel dogs that had pancreaticoduodenectomy. There was an average animal survival of 50.6 days and an average duration of normoglycemia of 41.8 days. We suggest that pancreaticoduodenal transplantation, which was abandoned as a clinical procedure 10 years ago, be reconsidered for clinical application.

Successful small bowel allotransplantation in dogs with cyclosporine and prednisone.

Twelve dogs had transplantation of almost the entire small intestine in the orthotopic location; immunosuppression was with cyclosporine and prednisone. Half the dogs had survival of at least one month, and a third lived for at least four months. Two of the animals are still living after 550 and 555 days. Maintenance of nutrition, and absorption of D-xylose and fat were better than in control animals with an iatrogenic short gut syndrome, but distinctly worse than that of normal dogs.