NEW LIVER SUPPORT SYSTEM USING EXVIVO PERFUSED LIVER

本研究旨在简化肝昏迷患者的肝支持系统（人工器官6(4):433-446,1982）。为了延长离体肝脏的保存时间，我们尝试将肝脏保存在略高于冰点的温度。此外，还研究了NO对衰竭肝脏能量代谢的影响机制。受体猪在门静脉分流术后结扎门静脉和肝动脉。用受体猪的动脉血灌注离体肝脏，同时监测离体灌注肝脏的代谢能力。用缺血性肝衰竭猪的动脉血灌注离体肝脏超过24小时是可能的。在肝衰竭猪的支持过程中，离体肝脏的活力得到了很好的维持。与肝衰竭猪连接的离体肝脏的耗氧量和胆汁产量显著高于与未肝衰竭猪连接的器官。这些发现表明，这种肝脏支持系统有足够的能力支持衰竭的肝脏。我们已经确定了大鼠肝脏的特定冰点，并将其保存在略高于冰点的温度下（-0.8℃）。与4℃保存的肝脏相比，在此温度下保存的肝脏腺嘌呤核苷酸代谢得到了很好的维持，这表明这种新的保存技术延长了保存时间。脓毒症合并肝功能衰竭患者血清NO水平升高，反映肝脏线粒体氧化还原状态的动脉血酮体比降低。NO水平与比值呈负相关。而在缺血肝猪中，一氧化氮含量没有增加。

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.