RECONSTRUCTIVE PROBLEMS IN CANINE LIVER HOMOTRANSPLANTATION WITH SPECIAL REFERENCE TO THE POSTOPERATIVE ROLE OF HEPATIC VENOUS FLOW

Abstract

The homologous canine liver has been transplanted to recipient animals in which total hepatectomy and splenectomy were performed. The longest survival after placement of the liver homograft was 20.6 days. Protection from hepatic ischemia for as long as 2 hours was obtained by cooling the donor liver to 10 to 20oC. The arterial supply was restored through a hepatic artery-aortic pedicle which was removed in continuity with the liver and anastomosed to the descending aorta of the recipient. Internal biliary drainage was established. The volume of venous flow transmitted to the transplanted liver was shown to be an important determinant of success. When this was excessive, as when both the portal and inferior caval flows were directed through the liver, hepatic outflow block usually developed with consequent fatal congestion of the hepatic and splanchnic beds. When the portal flow was normal or reduced, outflow block rarely occurred. An attempt has been made to relate the development of outflow block as it occurred in the transplanted liver to other circumstances, including hemorrhagic shock, in which phenomena have been observed.