Study on Liver Transplantation from Non-heart-beating Donors

由于脑死亡患者中出现的几个因素，器官状况可能会恶化。在这项研究中，我们在猪实验中研究了经皮心肺支持(PCPS)在预防因心脏压塞、窒息和心脏骤停等危重情况下造成的肝损伤的有效性。我们使用的是体重在12到18公斤之间的小猪。流出的插管插入下腔静脉或髂总静脉，流入的插管插入肾下腹主动脉或髂总动脉。我们使用了离心泵和膜式氧合器。在猪正常情况下，转流流量为1~1.5L/min。测定血气分析、肝酶、氨、乳酸、酮体比(AKBR、乙酰乙酸丁酯)和肝脏ATP的变化。心脏填塞和随后的降压后，ICG滞留率增加，这表明在这种情况下肝脏血流紊乱。未获得足够的旁路流量…心内直视手术期间ICG滞留率增加，提示此状态下肝脏血流紊乱。低氧30分钟后，血氨和乳酸升高，AKBR和肝组织ATP降低。对照组上述改变加重，30min内死亡。而脾动脉和颈动脉的血流在PCPS后基本恢复正常。在低氧状态下，我们获得了足够的旁路流量，流量在1.2~1.5 L/分钟之间。我们还观察了心内直视手术对心脏骤停后维持肝循环的效果。心内直视手术后立即开始心内直视手术，并持续2小时。在这些手术过程中，肝脏的氧气供应被潜在地维持着；在AKBR或肝脏ATP中，这种情况没有恶化。在心脏骤停后，旁路流量(600-800毫升/分钟)低于低静脉转流时。这些结果表明，PCPS在保护肝脏活力方面是有效的，在窒息或心脏骤停期间免受缺氧损害。PCP将扩大捐赠者的器官池。较少

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