Reconstructive problems in canine liver homotransplantation with special reference to the postoperative role of hepatic venous flow

Abstract

The homologous canine liver has been transplanted to recipient animals in which total hepatectomy and splenectomy have been performed. The longest survival after placement of the liver homograft was 20 1/2 days. Protection from hepatic ischemia for as long as 2 hours was obtained by cooling the donor liver to 10 to 20 degrees C. The arterial supply was restored through a hepatic artery-aortic pedicle which was removed in continuity with the liver and anastomosed to the descending aorta of the recipient. Internal biliary drainage was established. The volume of venous flow transmitted to the transplanted liver has been shown to be an important determinant of success. When this was excessive, as when both the portal and inferior caval flows were directed through the liver, hepatic and splanchnic beds. When the portal flow was normal or reduced, outflow block rarely occurred. An attempt has been made to relate the development of outflow block as it occurred in the transplanted liver to other circumstances, including hemorrhagic shock, in which similar phenomena have been observed.

FIG. 1

Basic technique of homotransplantation. a, Donor liver ready for transplant. Note aortic graft removed in continuity with hepatic artery and liver graft. b, Recipient with portacaval shunt and liver removed. c, Donor liver in place.

FIG. 2

Preparation of donor liver. Aortic graft prepared. Perfusion of cooled Ringer’s solution by gravity through the portal vein and collection of blood from the aorta.

FIG. 3

Decompression of portal and caval venous systems during complete occlusion of vena cava and portal vein by external shunt from femoral vein to external jugular vein.

FIG. 4

Technique of caval-caval anastomosis with posterior row being sutured from within.

FIG. 5

Methods of venous reconstruction. a, Reverse Eck fistula. b, Anatomic reconstruction with small porta-caval shunt. c, Complete anatomic reconstruction with closure of preliminary portacaval shunt.

FIG. 6

Rewarming curve of interior of donor liver exposed to room temperature for 1½ hours.

FIG. 7

Histologic changes in hepatic outflow block. a. Liver after 10 hours, showing congestion and early loss of architecture with dilated sinusoids. b. Another liver at 36 hours showing persistent congestion and marked disorganization of hepatic carchitecture. ×214.

FIG. 8

Intcstinal changes resulting from outflow hepatic block in dogs with reverse Eck fistula. a, Small intestine after 10 hours showing mucosal and submucosal congestion and submucosal edema. Note intact epithelium. ×11. b, Small intestine in another dog after 18 hours. There is congestion and loss of epithelium of distal portions of villi. ×44. c, Small intestine in a dog dying after 36 hours. Base of villi have partially intact epithelium, but distal villi are edematous and congested with marked slough of epithelial cove ring. ×44.