Study of the role of the splanchnic organs in hepatic atrophy for the purpose of auxiliary transplantation of the liver.

Many problems must be solved before auxiliary liver transplantations can be performed successfully in animals and in humans. The most important is the atrophy of the graft. To investigate the cause of this atrophy we have done experiments with seven series of dogs. We performed organ removals (splenectomy, pancreatectomy) and shunts (splenocaval derivation, mesenterico-caval shunt, spleno-mesentericocaval shunt). Five to eight dogs were used in each series. Hepatic biochemical tests, determination of hepatic blood flow (by 198 Au, (90)Kr, Bengal Rose, Indocyanine Green) and serial liver biopsies before and after surgery (and in the long survivals) were included in the study. Results have shown a flow decrease of 32.3% +/- SD 12.0 and 20.6% +/- SD 5.2 after mesenterico and spleno-cava derivations. Histologically, a swollen cytoplasm was encountered (probably due to this important flow decrease); but we did not find any modifications of the cells (atrophy) nor of their fat and glycogen contents. On the other hand, after pancreatectomy (flow decrease of 14.2% +/- SD 7.6) we found liver cord atrophy, bile retention, important fatty degeneration and disappearance of glycogen. All of these modifications were avoided by giving insulin subcutaneously after pancreatectomy. These results suggest that graft atrophy after auxiliary liver transplantation is due in part to an insufficient supply of insulin.