Study on cluster transplantation of whole abdominal organs, especially simultaneous transplantation of whole liver and pancreas

许多消化系统疾病患者的多个器官处于不可逆状态，可能需要进行全腹部器官移植以进行根治性治疗。特别是肝和胰腺这两个代谢中心的同时移植，在某些情况下是必要的。本研究旨在建立肝、胰腺联合全肝移植的手术方法，从脏器相互关系的角度探讨肝功能、胰腺内分泌功能的病理变化及排斥反应等免疫现象，评价术中、术后的处理。成年杂种犬同时接受肝脏移植的比较。胰腺移植、单纯肝移植和胰腺十二指肠移植的结果如下：(1)手术过程中的问题：供体移植物在4ﾟC下以80-100ml/kg…的速度灌流效果最佳更多/小时。在受体手术中，最成功的是动脉再通，低分子右旋糖酐输注。术中和术后处理以20~30ml/kg/h为宜。(2)2天和7天存活率：两组均不使用免疫抑制剂。肝胰腺联合移植组(n=8)2天和7天存活率分别为50%和38%，肝移植组(n=6)分别为67%和50%，胰腺移植组(n=5)分别为80%和60%。拒绝。(3)移植肝功能及能量代谢变化：移植后1~5d，各组大鼠肝功能基本恢复到术前水平，存活动物与死亡动物之间无明显差异。而动脉血中酮体比和静脉血中氨基酸浓度与再灌流后3h的预后密切相关。另外，间接量热法测定的静息能量消耗能准确反映再灌流30min后的转归。肝胰腺联合移植组的呼吸商明显高于肝移植或胰腺移植组，差异有统计学意义。与胰岛素分泌的相关性。(4)糖代谢与胰岛激素：肝胰腺联合移植术后即刻及术后5天或以上发生排斥反应时，可观察到特征性变化。前者的变化与移植胰腺功能的恢复程度有关，与胰岛激素分泌减少和肝损伤有关。后一种改变是胰腺内分泌功能的异常，与排斥反应的严重程度有关，单独移植胰腺后更为显著。较少

Multiple organs are in irreversible conditions in many patients with digestive disorders, and total abdominal organ transplantation may be required for radical treatment. Especially, simultaneous transplantation of the liver and the pancreas, which are the centers of metabolism, is indicated in some cases. This study was designed to establish the surgical procedure of simultaneous whole transplantation of liver and pancreas to closely evaluate intraoperative and postoperative management, as well as to investigate the pathology of the liver function and pancreatic endocrine functions and immunological phenomena such as rejection from the viewpoint of organ interrelations. Comparisons of adult mongrel dogs received simultaneous liver. and pancreas transplantation, liver transplantation alone, and pancreaticoduodenal transplantation yielded the following results.(1) Problems with operative procedure : The donor graft was best perfused with Ringer's solution at 4ﾟC at a rate of 80-100ml/kg … More /hour. In operation of the recipient, reperfusion was started most successfully in the artery, and low-molecular-weight dextran infusion at. 20-30ml/kg/hour was appropriate for intraoperative and postoperative management.(2) 2-day and 7-day survival rates : No immunosuppressants were administered in any group. The 2-day and 7-day survival rates were 50% and 38%, respectively, in the simultaneous liver and pancreas transplantation group (n=8), 67% and 50%, respectively, in the liver transplantation group (n=6), and 80% and 60% respectively, in the pancreas transplantation group (n=5). Rejection. was observed 5 or more days after transplantation in all groups.(3) Liver graft function and changes in energy metabolism The general liver function returned to the preoperative level 1-5 days after transplantation in all groups, and no significant difference was observed between the animals that died and those that survived. However, ketone body ratio in the arterial blood and amino acid concentrations in the venous blood 3 hours after reperfusion showed close correlations with the outcome. Moreover, the resting energy consumption determined by indirect calorimetry 30 minutes after reperfusion accurately reflected the outcome. The respiratory quotient was significantly higher in the simultaneous liver and pancreas transplantation group than in the liver transplantation or pancreas transplantation group and showed. a correlation with insulin secretion.(4) Carbohydrate metabolism and pancreatic islets hormones : Characteristic changes after simultaneous liver and pancreas transplantation were observed immediately after reperfusion and 5 or more days after operation, when rejection developed. The former changes were dependent on the degree of recovery in the viability of the graft pancreas function and were related with a decrease in pancreatic islets hormones secretion and liver injury. The latter changes were abnormalities in pancreatic endocrine function dependent on the severity of rejection, and were more notable after transplantation of the pancreas alone. Less