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，根治性治疗可能需要全腹部器官移植。特别是，在某些情况下，作为代谢中心的肝脏和胰腺的同时移植是必要的。本研究旨在建立完整的肝胰联合移植的手术方法，以密切评估术中和术后管理，并从器官相互关系的角度探讨肝功能和胰腺内分泌功能的病理学和免疫学现象，如排斥反应。成年杂种犬同时接受肝脏的比较。胰腺移植、单独的肝移植和胰十二指肠移植产生了以下结果。(1)手术操作问题：供体移植物最好在4 ℃下以80- 100 ml/kg的速率用林格氏液灌注 ...更多信息 /小时。在受体的手术中，再灌注在动脉中开始最成功，低分子量右旋糖酐输注在。术中、术后管理以20- 30 ml/kg/h为宜。(2)2天和7天生存率：任何组均未给予免疫抑制剂。肝胰联合移植组（n=8）2 d和7 d生存率分别为50%和38%，肝移植组（n=6）2 d和7 d生存率分别为67%和50%，胰腺移植组（n=5）2 d和7 d生存率分别为80%和60%。排斥反应移植后5天或更长时间观察到所有组。(3)肝移植功能和能量代谢的变化所有组的一般肝功能在移植后1-5天恢复到术前水平，并且在死亡和存活的动物之间没有观察到显著差异。而再灌注3 h后动脉血酮体比值和静脉血氨基酸浓度与预后密切相关。此外，再灌注后30分钟通过间接量热法测定的静息能量消耗准确地反映了结果。肝胰联合移植组的呼吸商明显高于肝移植组或胰移植组，并有统计学意义。与胰岛素分泌相关。(4)碳水化合物代谢和胰岛激素：在再灌注后即刻和术后5天或更长时间发生排斥反应时观察肝和胰腺联合移植后的特征性变化。前者的变化依赖于移植胰腺功能的恢复程度，与胰岛激素分泌减少和肝损伤有关。后一种变化是胰腺内分泌功能的异常，取决于排斥反应的严重程度，并且在单独胰腺移植后更显着。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