Pienaar B H, Lindell S L, Van Gulik T, Southard J H, Belzer F O
Department of Surgery, Clinical Science Center, Madison.
Surg Gynecol Obstet. 1989 Oct;169(4):341-6.
Experimental transplantation of the liver is a complex procedure, and technical considerations can often complicate the interpretation of results from studies of hepatic preservation. Improvement in experimental transplantation techniques will decrease adverse effects of the procedure on laboratory animals and assist in the development of improved preservation techniques. The procedure should be designed to mimic the clinical situation. The technique described herein differs from previously described techniques in the operation upon the donor. The bile duct is preserved for anastomosis to the recipient bile duct. The liver is isolated on vascular pedicles, with a new approach to the infrahepatic inferior vena cava, which decreases blood loss. Subdiaphragmatic transection of the suprahepatic inferior vena cava ensures a short segment that cannot twist or telescope into the transplanted liver. The hepatic artery is dissected to the level of the aorta, in contrast with the aorta being used as a conduit. Nonheparinized blood is collected from the hepatic donor. During the operation upon the recipient, the approach to the infrahepatic vena cava minimizes blood loss. A new method of hepaticohepatic arterial anastomosis with preservation of the duodenal blood supply is described. A passive shunt for mesenteric blood flow is used. The bile duct is preserved and choledochocholedochal anastomosis is performed over a stent. The operating time of both harvesting and transplanting was considerably shorter compared with that of reports in the literature and with previous methods used in our laboratory. No dissection of the cold organ was done. There was no incidence of venous outflow obstruction, as previously described. With this technique, blood transfusion of only 1 unit (425 milliliters) resulted in an elevated hemoglobin concentration postoperatively. In 20 consecutive transplants, no failure occurred as a result of technical reasons. This new method appears to simplify the procedure, reduce operating time, is less stressful to the dogs and has produced results superior to those from our previous methods. This method would appear to be easily adaptable to other laboratories interested in hepatic transplantation.
