Veno-venous bypass in Orthotopic Liver Transplantation for children: Experimental study in pigs and dogs

实验一：在5头猪（体重约15 kg）上观察了门体分流术流量对受体无肝期血流动力学变化的影响。分离猪肝，并使用离心泵（Bio-pump）将体静脉和内脏静脉流分流至颈外静脉<TM>。平均动脉压（MAP）随着转流流量的增加而升高，当泵流量超过20 ml/kg时，MAP维持在100 mmHg以上，与术前值无显著差异。当泵流量增加到20 ml/kg时，全身静脉阻力（SVR）明显下降。实验二：供体肝脏经门静脉和肝动脉原位灌注冷乳酸林格液。将它们在相同的溶液中在4 ℃下保存1小时，并进行以下实验以使用钾水平作为标记来评估保存期间的冷缺血损伤： ...更多信息 取离体肝的静脉。(b)门静脉重建后即刻经肝下下腔静脉获得初始灌注液，同时夹闭肝上下腔静脉。实验三：27只犬（n=18）和猪（n=9）原位肝移植，采用离心泵，流量20 ml/kg，门静脉重建前用冷乳酸林格液10-15 ml/kg冲洗。术后能自主呼吸10 h以上的犬血清S-GOT水平高于10 h以内的犬。在耐受移植并存活两周的猪中，实验后12小时内S-GOT、凝血酶原时间和肝促活酶试验水平的初始变化在接下来的6小时内恢复。这可能提示移植后12至18小时可能是可能的原发性移植物衰竭的关键时期。少

Experiment I: Effect of the flow volume of the porto-systemic bypass on the hemodynamic change of the recipient in anhepatic phase was evaluated in five pigs (15kg of approximate body weight). The pig liver was isolated and the systemic and splanchnic venous flow was shunted to the external jugular vein using centrifugal pump (Bio-pump^<TM>). Mean arterial pressure (MAP) elevated by increasing flow volume of the bypass, and MAP was well maintained over 100mmHg, which was not significantly different from a pre-op. value, when a pump flow was given over 20ml/kg. Systemic Venous Resistance (SVR) markedly dropped when the pump flow increased to 20ml/kg.Experimental II: Donor livers were perfused in situ via the portal vein and hepatic artery with cold lactate ringer solution. They were kept in the same solution at 4C for one hour, and following experiments were carried out to evaluate the cold ischemic damage during preservation using potasium level as a marker: (a) Effluents from the hepa … More tic vein of the isolated liver were sampled. (b) Initial perfusate right after reconstruction of the portal vein was obtained through infrahepatic IVC with supra hepatic IVC clamped. The concentration of K+ was significantly lowered by washing out the donor liver with an amount of 10-15ml/kg of solutions.Experiment III: Twenty seven orthotopic liver transplantation were performed in dogs (n=18) and pigs (n=9) using a centrifugal pump with 20ml/kg of a flow volume and a wash out technique with 10-15 ml/kg of cold lactate ringer solution before portal reconstruction. S-GOT level was higher In a group of dogs which could go on their spontaneous breathing for more than 10 hours after operation than that was less than 10 hours. in a pig which tolerated transplantation and survived for two weeks, initial change of the levels of S-GOT, prothrombin time, and hepaplastin test in twelve hours after experiment turned to recover in next six hours. this might suggest that 12 to 18 hours after transplantation could be a critical period for possible primary graft failure. Less