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器官处于不可逆状态，可能需要全腹部器官移植进行根治性治疗。特别是，在某些情况下，肝脏和胰腺是代谢的中心，需要同时移植。本研究旨在建立肝胰腺同时全移植的手术方法，严密评价术中及术后处理，并从器官相互关系的角度探讨肝功能、胰腺内分泌功能病理及排斥反应等免疫现象。成年杂种犬同步肝移植的比较。胰腺移植、单独肝移植和胰十二指肠移植的结果如下。(1)手术过程中存在的问题：供体移植物以4个氯丙酸的林格液灌注为宜，灌注速率为80-100ml/kg…More /h。在受体手术中，动脉再灌注最成功，低分子葡聚糖输注于。术中、术后处理以20 ~ 30ml/kg/h为宜。(2) 2天和7天生存率：各组均未使用免疫抑制剂。肝胰同时移植组2天和7天生存率分别为50%和38% (n=8)，肝移植组为67%和50% (n=6)，胰移植组为80%和60% （n=5）。被拒绝。在移植后5天或更长时间观察。(3)肝移植功能及能量代谢变化各组移植后1 ~ 5 d肝功能恢复到术前水平，死亡与存活动物无显著差异。再灌注3小时后动脉血酮体比和静脉血氨基酸浓度与预后密切相关。此外，间接量热法测定再灌注后30分钟的静息能量消耗准确反映了结果。肝胰同时移植组呼吸商明显高于肝胰同时移植组，并显示。与胰岛素分泌有关。(4)碳水化合物代谢及胰岛激素：肝胰同时移植术后，在再灌注后立即及术后5天及以上发生排斥反应时观察特征性变化。前者的改变取决于移植胰腺功能活力的恢复程度，并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，依赖于排斥反应的严重程度，在胰腺单独移植后更为明显。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