Technique for procurement of heart, liver and kidneys from a single donor for transplantation.

The purpose of this report is to present a safe, simple technique for procurement of the heart, liver, and kidneys from a single donor with no warm ischemic time. Twenty mongrel dogs were divided into 5 groups of 3 recipients and 1 donor each. Liver and kidney mobilization was performed when the core temperature of the liver reached 27 degrees C, a result of ice slush in the abdominal cavity. As the core temperature of the liver reached 20-22 degrees C, the aorta and inferior vena cava were clamped just above the diaphragm. After excision of the liver and kidneys, another team harvested the heart as it continued to beat. The heart and liver were transplanted orthotopically after simple preservation for 12 and 6 hours, respectively. The kidney was transplanted heterotopically after simple 12-hour preservation. The maximum survival time was 7 hours for heart transplantation and 16 days for liver transplantation. Kidney homogenate ATP levels decreased to 19% of baseline after preservation and were restored to 68% one hour after reperfusion. Our method is simple and safe for harvesting the heart, liver, an kidneys for transplantation and may offer a definite possibility for clinical application.

[Abdominal multi-organ transplantation in dogs].

Abdominal multi-organ transplantation including the liver, gallbladder, spleen, pancreas, kidneys, adrenal glands and gastrointestinal tract was attempted in 8 dogs. Each experiment was discontinued when the recipient deteriorated. Immersion hypothermia was introduced in both the donor and recipient until the esophageal temperature reached 27-30 degrees C. Whole abdominal organs of the donor were removed in an en-bloc fashion at 20 degrees C of the graft temperature after additional cooling by ice slush scattering into the abdominal cavity. Transplantation was carried out orthotopically in the following sequence: (1) the proximal aorta, (2) suprahepatic vena cava, (3) distal aorta, (4) infrahepatic vena cava. The alimentary tract was reconstructed by gastro-gastrostomy and colo-colostomy. The ureters were implanted in the bladder. Cold ischemic time of the graft was about 40 minutes. Heparin was not used throughout the procedure. Five out of eight dogs were alive for more than 24 hours and two of them survived for 60 hours with good recovery. No immunosuppressant was given. Though the result in the present study was far from satisfaction, the experiment may provide a possibility of a new experimental model for transplantation, especially regarding pathophysiology and interrelationship of the transplanted complex organs.

Simultaneous retrieval of the heart and liver from a single donor: an evaluation through preservation and transplantation.

The simple, safe, and feasible procurement technique for the heart and liver with no warm ischemic time is reported. Fifteen mongrel dogs were used to form two recipients and one donor combination in each experiment. A midline incision is extended from the suprasternal notch to the pubis, and a catheter is advanced into the aortic root by means of the brachiocephalic artery for monitoring systemic arterial pressure and later for coronary vascular washout with a cold cardioplegic solution. Liver mobilization is carried out first when the core temperature of the liver reaches 27 degrees C, obtained with ice slush in the abdominal cavity. As the core temperature of the liver reaches 20 degrees to 22 degrees C, the aorta and inferior vena cava are clamped just above the diaphragm. After excision of the liver a second team harvests the heart while it continues to beat. The heart and liver were transplanted orthotopically after simple preservation into a cold solution for 12 and 6 hours, respectively. The maximum survival time was 7 hours in heart transplantation and 16 days in liver transplantation. Our method is a simple, safe, feasible technique for acquiring the heart and liver or other visceral organs for transplantation and may have broad clinical application.

[Orthotopic allotransplantation of the canine liver; a simplified technic with hypothermia].

A simplified technique of the liver transplantation under hypothermia has been studied in dog. An immersion hypothermia was used in both the donor and the recipient. The temperature of the graft at excision was lowered to 20 degrees C with supplemental use of topical cooling. The temperature of the recipient was lowered at 27 degrees C when the transplantation was attempted. Chlorpromazine and dopamine were employed beneficially in hypothermia. No perfusion or irrigation of the graft was performed. The use of heparin was avoided. Anastomoses were carried out in turn of the proximal vena cava, portal vein, distal vena cava and the hepatic artery with a stem shaped aorta. Reperfusion was established after the completion of anastomosis between the proximal vena cava and portal vein. The anhepatic phase of the recipient was uneventfully lasted without heparinization. All dogs, 5 out of 11 without early surgical troubles survived more than 5 days. Immunosuppressive therapy was not employed except one which died of pneumonia on the 19th postoperative day. Histologically, these dogs were free from ischemic injury and/or thrombotic lesion throughout transplantation procedure.