NEW LIVER SUPPORT SYSTEM USING EXVIVO PERFUSED LIVER

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This study was conducted to simplify our liver support system used in patients with hepatic coma (Artificial Organ 6(4) : 433-446,1982). To prolong preservation time of the isolated liver, we tried to preserve the liver at a temperature just above the freezing point. In addition, the mechanism was studied by which NO affects the energy metabolism of the failed liver.1. The recipient pigs underwent a ligation of the portal vein and hepatic artery following portacaval shunt. An isolated liver was perfused with arterial blood from the recipient pig while monitoring the metabolic capacity of the ex vivo perfused liver. It was possible to perfuse the isolated liver for more than 24 hours using arterial blood from a pig with ischemic liver failure. The viability of the isolated liver during support of the liver failure pig was well maintained. The oxygen consumption and bile production were significantly higher in the isolated liver connected to the liver failure pig than in the organ connected to the pig without liver failure. These findings suggest that this liver support system has sufficient capacity to support a failed liver.2. We have confirmed the specific freezing point of rat liver and preserve it at a temperature just above that point (-0.8 C). Adenine nucleotide metabolism of the liver preserved at this temperature was well maintained as compared with the organ preserved at 4 C. It is suggested that this novel preservation technique prolong the preservation period.3. In septic patients with liver failure, NO levels in sera were increased and arterial blood ketone body ratio reflecting liver mitochondrial redox state, was depressed. There was a reciprocal relationship between NO level and the ratio. However, in the pig with ischemic liver NO was not increased.