Study on Liver Transplantation from Non-heart-beating Donors

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The organ condition might be aggravated due to several factors seen in brain-death patients. In this study, we investigated the efficacy of percutaneous cardio-pulmonary support (PCPS) to prevent liver damage due to critical conditions, including cardiac tamponade, asphyxia, and cardiac arrest in pig experiments. We used infant pigs weighing between 12 and 18 Kg. The outflow cannulas were inserted into the inferior caval vein or common iliac vein ; the inflow cannulas were into infrarenal abdominal aorta or common iliac artery. We used a centrifugal pump and a membrane oxygenator. The bypass flow ranged from 1 to 1.5L/min in a normal condition of the pigs. We measured changes in blood gas analysis, liver enzymes, ammonia, lactate, ketone body ratio (AKBR,acetoacetate/3OH-butyrate), and liver ATP.After cardiac tamponade and subsequent hypotension, ICG retention rate increased, which indicates the disturbance of hepatic blood flow in this condition. Adequate bypass flow was not obtained … More during PCPS in this experiment possiblly due to low venous return.After cardiac tamponade and subsequent hypotension, ICG retention rate increased, which indicates the disturbance of hepatic blood flow in this condition. Adequate bypass flow was not obtained during PCPS in this experiment possiblly due to low venous return.After 30 min.of hypoxia, increases in ammonia and lactate and decreases in AKBR and liver ATP were observed. These changes was aggravated and pigs died within 30 min.in the control group. On the other hand, these changes returned to normal after PCPS.These is no difference in arterial flow between the splenic artery and the carotid artery. Adequate bypass flow ranging from 1.2 to 1.5 L/min was obtaind during hypoxia.We also evaluated the efficacy of PCPS to maintain the hepatic circulation after cardiac arrest. PCPS together with intrrabdominal cooling using ice slush was started immediately after cardiac arest and continued for two hours. Oxygen supply of the liver was potentially maintained during these procedures ; these was no aggravation in AKBR or liver ATP.After cardiac arres, the bypass flow was lower (600-800 ml/min) than during hypovenutilation.These result indicate the efficacy of PCPS in preserving the viability of the liver from anoxic damage during asphyxia or cardiac arrest. PCPS will expand the pool of the donor organs. Less