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Liver Graft Revascularization by Donor Portal Vein Arterialization Following “No Touch” Donor Hepatectomy
Unsatisfactory immediate function of the transplanted liver together with technical complications contribute to a persisting early mortality for hepatic transplantation in the 20% range. We report our initial clinical experience with methods, one not previously used clinically, that resulted in unif...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Texto |
Lenguaje: | English |
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Hindawi Publishing Corporation
1988
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2423504/ https://www.ncbi.nlm.nih.gov/pubmed/3153776 http://dx.doi.org/10.1155/1988/97019 |
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author | Sheil, A. G. R. Thompson, J. F. Stephen, M. S. Graham, J. C. Eyers, A. A. Bookallil, M. Kalpokas, M. McCaughan, G. W. Dorney, S. F. A. Ekberg, H. B. N. Mears, D. Kelly, G. E. Woodman, K. |
author_facet | Sheil, A. G. R. Thompson, J. F. Stephen, M. S. Graham, J. C. Eyers, A. A. Bookallil, M. Kalpokas, M. McCaughan, G. W. Dorney, S. F. A. Ekberg, H. B. N. Mears, D. Kelly, G. E. Woodman, K. |
author_sort | Sheil, A. G. R. |
collection | PubMed |
description | Unsatisfactory immediate function of the transplanted liver together with technical complications contribute to a persisting early mortality for hepatic transplantation in the 20% range. We report our initial clinical experience with methods, one not previously used clinically, that resulted in uniformly well-functioning liver grafts in 11 patients and contributed to a satisfactory success rate for the procedure. Donors were heart-beating. During the donor operation all manipulations of the liver were avoided until after cold preservation, achieved by external cooling at the same time as circulatory interruption, donor exsanguination and perfusion of the liver with cold oxygenated fluid of “extracellular̵ type. The organs were then gently dissected. At transplantation the livers were revascularized with arterial blood shunted from the recipient iliac artery to the graft portal vein after completion of the suprahepatic IVC anastomosis. The infrahepatic IVCs and hepatic arteries were then joined, the iliac artery shunts discontinued and the portal veins joined. Total ischaemic intervals for the allografts were 3½–8 (average 5). Anhepatic intervals were 1–2¼ (average 2). The arterio-portal shunts were operating for 18–85 (mean 46) min. Blood loss and haemodynamic, acid-base and electrolyte abnormalities at revascularization were minimal. All grafts secreted bile immediately and all parameters reflected continuing improvement of liver function thereafter. Nine patients (82%) are alive between 4 and 18 (mean 11) months after transplantation. We conclude that these methods offer effective avoidance of serious organ damage during donor hepatectomy and preservation, reduced allograft ischaemic interval and reduced recipient anhepatic time. They result in avoidance of blood loss at the time of revascularization, together with minimal haemodynamic, acid-base or biochemical changes. In addition, they allow the surgeon to perform and test all anastomoses without time constraints, provide the capability to deal with unexpected complications, and assure good early graft function. |
format | Text |
id | pubmed-2423504 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 1988 |
publisher | Hindawi Publishing Corporation |
record_format | MEDLINE/PubMed |
spelling | pubmed-24235042008-07-08 Liver Graft Revascularization by Donor Portal Vein Arterialization Following “No Touch” Donor Hepatectomy Sheil, A. G. R. Thompson, J. F. Stephen, M. S. Graham, J. C. Eyers, A. A. Bookallil, M. Kalpokas, M. McCaughan, G. W. Dorney, S. F. A. Ekberg, H. B. N. Mears, D. Kelly, G. E. Woodman, K. HPB Surg Research Article Unsatisfactory immediate function of the transplanted liver together with technical complications contribute to a persisting early mortality for hepatic transplantation in the 20% range. We report our initial clinical experience with methods, one not previously used clinically, that resulted in uniformly well-functioning liver grafts in 11 patients and contributed to a satisfactory success rate for the procedure. Donors were heart-beating. During the donor operation all manipulations of the liver were avoided until after cold preservation, achieved by external cooling at the same time as circulatory interruption, donor exsanguination and perfusion of the liver with cold oxygenated fluid of “extracellular̵ type. The organs were then gently dissected. At transplantation the livers were revascularized with arterial blood shunted from the recipient iliac artery to the graft portal vein after completion of the suprahepatic IVC anastomosis. The infrahepatic IVCs and hepatic arteries were then joined, the iliac artery shunts discontinued and the portal veins joined. Total ischaemic intervals for the allografts were 3½–8 (average 5). Anhepatic intervals were 1–2¼ (average 2). The arterio-portal shunts were operating for 18–85 (mean 46) min. Blood loss and haemodynamic, acid-base and electrolyte abnormalities at revascularization were minimal. All grafts secreted bile immediately and all parameters reflected continuing improvement of liver function thereafter. Nine patients (82%) are alive between 4 and 18 (mean 11) months after transplantation. We conclude that these methods offer effective avoidance of serious organ damage during donor hepatectomy and preservation, reduced allograft ischaemic interval and reduced recipient anhepatic time. They result in avoidance of blood loss at the time of revascularization, together with minimal haemodynamic, acid-base or biochemical changes. In addition, they allow the surgeon to perform and test all anastomoses without time constraints, provide the capability to deal with unexpected complications, and assure good early graft function. Hindawi Publishing Corporation 1988 /pmc/articles/PMC2423504/ /pubmed/3153776 http://dx.doi.org/10.1155/1988/97019 Text en Copyright © 1988 Hindawi Publishing Corporation. http://creativecommons.org/licenses/by/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Sheil, A. G. R. Thompson, J. F. Stephen, M. S. Graham, J. C. Eyers, A. A. Bookallil, M. Kalpokas, M. McCaughan, G. W. Dorney, S. F. A. Ekberg, H. B. N. Mears, D. Kelly, G. E. Woodman, K. Liver Graft Revascularization by Donor Portal Vein Arterialization Following “No Touch” Donor Hepatectomy |
title | Liver Graft Revascularization by Donor Portal Vein Arterialization Following “No Touch” Donor Hepatectomy
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title_full | Liver Graft Revascularization by Donor Portal Vein Arterialization Following “No Touch” Donor Hepatectomy
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title_fullStr | Liver Graft Revascularization by Donor Portal Vein Arterialization Following “No Touch” Donor Hepatectomy
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title_full_unstemmed | Liver Graft Revascularization by Donor Portal Vein Arterialization Following “No Touch” Donor Hepatectomy
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title_short | Liver Graft Revascularization by Donor Portal Vein Arterialization Following “No Touch” Donor Hepatectomy
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title_sort | liver graft revascularization by donor portal vein arterialization following “no touch” donor hepatectomy |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2423504/ https://www.ncbi.nlm.nih.gov/pubmed/3153776 http://dx.doi.org/10.1155/1988/97019 |
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