Suprahepatic vena cava anastomosis of the donor liver to the recipient retrohepatic vena cava in canine liver transplantation

A revised method of the upper caval anastomosis in canine orthotopic liver transplantation is described. It uses the recipient retrohepatic inferior vena cava below the suprahepatic veins for vascular suturing. Ten consecutive operations were performed to assess the feasibility of this method, with special reference to the outflow obstruction at the level of the suprahepatic inferior vena cava. Seven of 10 dogs survived more than 6 days. The cause of death was not related to the outflow obstruction in any instance. Regardless of the duration of survival, free hepatic vein pressures as well as portal vein pressures of all dogs remained in the physiological range even after the skin closures. Based on these observations, we conclude that this approach is safe and reproducible in experimental transplantation of the canine liver.

[The direct hemodynamic effects of dopamine on hepatic blood flow in the dog--use of direct hemoperfusion (DHP) under hepatic venous isolation (HVI)]

We studied the direct effects of dopamine on hepatic blood flow using DHP under HVI. Dopamine was given to mongrel dogs through either the right antecubital vein (group I: n = 3), the hepatic artery-HA (group II: n = 7) or the portal vein-PV (group III: n = 6). In groups II and III, DHP under HVI was performed to eliminate the cardiovascular influence caused by the extraregional distribution of dopamine. In group I, HA/AO decreased from 2 +/- 10 to 29 +/- 9% with infusions of dopamine from 1 to 10 micrograms/kg/min. The peak increase in PV/AO was only 14 +/- 11%. In groups II and III, plasma concentrations of dopamine in the hepatic venous blood were reduced to as low as 2.7 +/- 1.6% after DHP, and AO flow remained unaltered. Dopamine infusions in doses from 0.25 to 10 micrograms/kg/min through HA and PV resulted in dose dependent reductions of HA/AO from 4 +/- 14 and 10 +/- 9% to 42 +/- 12 and 51 +/- 11%, respectively. In contrast, PV/AO remained unchanged. Although alpha 1 antagonist reversed these hemodynamic effects, no remarkable change was observed with DA1-antagonist. In conclusion, dopamine seems to act at the site of either sinusoidal or post-sinusoidal level probably as an alpha-agonist. In addition to dopamine's effect on PV flow, our study indicates that increased attention should be given to its activity in reducing HA flow.

Successful 96-hour preservation of the canine pancreas

We tested the preservation of the pancreas for 96 h by a modified two-layer (UW solution/perfluorochemical) cold storage method (group 1) in the canine model of pancreas autotransplantation and compared this with an original two-layer (Euro-Collins' solution/perfluorochemical) cold storage method (group 2) and simple cold storage method with UW solution (group 3). A graft was considered functioning if the dog had a normal blood glucose for at least 5 days after transplantation. The functional success rates after preservation for 72 h were 100%, 100% and 80% for groups 1, 2 and 3 respectively. On the other hand, the functional success rates for groups 1, 2 and 3 after preservation for 96 h were 75%, 0% and 0% respectively. The mean K value of 96-hour preserved grafts for group 1 at 2 weeks after transplantation was 1.52 +/- 0.30 compared with 1.98 +/- 0.48 before preservation. Biopsies of grafts from group 1 showed almost normal pancreatic architecture even after preservation for 96 h. In addition, biopsies of grafts preserved for 96 h in group 1 at 4 weeks after transplantation showed almost normal endocrine tissue with mild fibrosis of the exocrine tissue. This study demonstrated the possibility of preserving the pancreas for 96 h prior to transplantation.

The mechanism of action of the two-layer (Euro-Collins' solution/perfluorochemical) cold storage method in canine pancreas preservation

To clarify the mechanism of action of a two-layer [Euro-Collins' solution (EC)/perfluorochemical (PFC)] cold storage method in the preservation of the pancreas, pancreatic viability and tissue concentrations of adenosine triphosphate (ATP) were examined in the canine model of pancreatic autotransplantation after preservation for 24 and 48 h by simple cold storage in EC (group 1), the two-layer, EC/PFC, method (group 2) and the two-layer, EC+2, 4 dinitrophenol (DNP)/PFC, method (group 3). DNP is an uncoupler of oxidative phosphorylation. Maintenance of normoglycemia for at least 5 days after transplantation was considered a successful preservation. After preservation for 24 h, the functional success rates of groups 1, 2 and 3 were 100% (4/4), 100% (5/5) and 80% (4/5) respectively. One of five dogs in group 3 died of a cause unrelated to the pancreas. ATP tissue concentrations in group 2 were significantly higher than in group 1 (7.47 +/- 0.47 micromol/g dry weight vs 1.41 +/- 0.53 micromol/g dry weight, P < 0.01) and ATP tissue concentrations in group 3 were significantly lower than in group 2 (1.25 +/- 0.37 micromol/g dry weight vs 7.47 +/- 0.47 micromol/g dry weight, P < 0.01). It was apparent that ATP was not an essential factor for successful 24-hour preservation of the canine pancreas in EC because all the pancreatic grafts except one of five grafts in group 3 remained viable after preservation for 24 h, regardless of ATP tissue concentrations. On the other hand, after preservation for 48 h, the functional success rates for groups 1, 2 and 3 were 0% (0/4), 100% (4/4) and 0% (0/3) respectively. ATP tissue concentrations in group 2 were significantly higher than in group 1 (7.91 +/- 1.21 micromol/g dry weight vs 1.21 +/- 0.31 micromol/g dry weight, P < 0.01) and ATP tissue concentrations in group 3 were significantly lower than in group 2 (0.61 +/- 0.07 micromol/g dry weight vs 7.91 +/- 1.21 micromol/g dry weight, P < 0.01). It was clear that preservation of the pancreas for 48 h was unsuccessful by simple cold storage in EC (group 1) and the two-layer method (group 2) made preservation for 48 h possible by increasing ATP tissue concentrations. However, DNP (group 3) inhibited the synthesis of ATP and the effectiveness of the two-layer method for 48-hour preservation of the pancreas. It was clear that maintenance of high ATP tissue concentrations during preservation was essential for the successful preservation of the canine pancreas in EC by the two-layer method for more than 48 h. We concluded that an adequate supply of oxygen to the pancreas during preservation by the two-layer method led to sufficient production of ATP to maintain cellular integrity and permitted the improvement of pancreatic preservation.

Correlation between high adenosine triphosphate tissue concentration and good posttransplant outcome for the canine pancreas graft after preservation by the two-layer cold storage method

Assessment of viability of a pancreas graft during preservation is very important to avoid transplantation of a nonfunctioning allograft. In the present report the correlation between adenosine triphosphate tissue concentration at the end of cold preservation by the two-layer method and viability a of canine pancreas graft following transplantation was studied. After preservation by an original two-layer (Euro-Collins' solution/perfluorochemical) method (group 1) and a modified two-layer (University of Wisconsin solution/PFC) method (group 2) for 24, 48, 72, 96, and 120 hr (subgroups A, B, C, D, and E), the tissue concentration of ATP was determined using high-performance liquid chromatography, and the viability of the pancreas graft was tested in the canine model of segmental pancreas autotransplantation. Maintenance of normoglycemia for at least five days after transplantation was considered to indicate a viable pancreas graft. In group 1, functional success rates were A: 5/5, (100%), B: 4/4 (100%), C: 4/4, (100%), and D: 0/4 (0%), respectively. The ATP tissue concentrations were 7.47 +/- 0.47 (n = 5), 7.91 +/- 1.21 (n = 4), 8.29 +/- 0.21 (n = 4), and 4.94 +/- 1.11 (n = 4) mumol/g dry weight in groups 1A, 1B, 1C, and 1D, respectively. There was a statistically significant difference between viable groups (groups 1A, 1B, and 1C, 7.86 +/- 0.77 mumol/g dry weight [n = 13]) and the nonviable group (group D, 4.94 +/- 1.11 mumol/g dry weight (n = 4) (P less than 0.01). On the other hand, the functional success rates were 3/3 (100%), 3/3 (100%), 3/3 (100%), 5/7 (71%), and 0/3 (0%) in groups 2A, 2B, 2C, 2D, and 2E, respectively. Two of seven dogs died of causes related to the grafts (pancreatitis and thrombosis). The ATP tissue concentrations were 8.53 +/- 1.45 (n = 3), 9.64 +/- 1.77 (n = 3), 13.81 +/- 2.09 (n = 3), and 12.49 +/- 2.52 (n = 5) mumol/g dry weight in groups 2A, 2B, and 2C and in viable grafts in group 2D, respectively, but the ATP tissue concentration of nonviable grafts in group 2D and group E were 3.51 +/- 0.81 (n = 2) and 3.98 +/- 1.34 (n = 3) mumol/g dry weight, respectively. There was a statistically significant difference between viable groups (groups 2A, 2B, 2C and viable grafts in group 2D, 11.03 +/- 2.72 mumol/g dry weight [n = 14]) and nonviable groups (group E and nonviable grafts in group 2D, 3.79 +/- 1.06 mumol/g dry weight [n = 5]) (P less than 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)

[A new method of intraarterial high dose chemotherapy for unresectable hepatomas using direct hemoperfusion under hepatic venous isolation (HVI.DVP)]

We have recently developed a simple method of high dose chemotherapy using HVI.DHP. The effect of HVI.DHP was evaluated in the elimination of anticancer drugs. Adriamycin (ADR: 3mg/kg), mitomycin C (MMC:1mg/kg) and cisplatin (CDDP: 2mg/kg) were given to mongrel dogs through the hepatic artery with or without HVI.DHP. The drug removal rates were similar in three drugs. Area under the curve and peak systemic level of each drug were substantially reduced by means of HVI.DHP, the values of ADR, MMC and CDDP being 17.4 and 6.2%, 4.5 and 5.9%, and 24.6 and 23.1%, respectively, of the corresponding values of simple hepatic artery infusions. Ten patients with unresectable hepatomas were treated by intraarterial high dose ADR (100-150mg/m2) using HVI.DHP. All except for two patients with catheter related complications recovered uneventfully and showed marked reductions of serum alpha-fetoprotein. Complete response was observed in one and partial response in five patients, for an overall response rate of 60%. Systemic toxicities of ADR were minimized: no cardiotoxicity, leucopenia less than 1000 cells/mm3 in one and mild hair loss in six patients. On the basis of these results, we consider this method to be an attractive therapeutic option for hepatic tumors.

[A new method of intraarterial high dose chemotherapy for unresectable hepatocellular carcinoma--the effect of direct hemoperfusion under hepatic venous isolation]

We undertook hepatic artery infusion of high dose adriamycin (ADR) in three patients with unresectable hepatocellular carcinoma utilizing direct hemoperfusion (DHP) under hepatic venous isolation (HVI). 5 minutes continuous infusion of ADR at dosages of 100 and 150 mg/m2 was combined with DHP of 20 and 30 minutes, respectively. HVI was established by occlusions of suprahepatic and retrohepatic vena cava using a tourniquet tape and a cuff-cannula. During HVI, hepatic venous outflow was directed toward DHP and joined with the rest of the intra-caval blood before the centrifugal pump connected to a return cannula to the left axillary vein. Systemic levels of ADR were maintained less than 2 micrograms/ml during the treatments in three patients. The estimated drug removal rates were 72.3%, 51.2% and 31.1% respectively. Hematologic changes due to DHP were tolerable and transient. Highest values of serum transaminases were demonstrated on day 2 and rapidly recovered to the pretreatment levels within a week. Postoperative CT studies revealed also marked reduction in tumor size. We consider this method an attractive therapeutic option for patients with advanced hepatocellular carcinoma.

Extracorporeal removal of anticancer drugs in hepatic artery infusion: the effect of direct hemoperfusion combined with venovenous bypass

The effect of a new extracorporeal system combining direct hemoperfusion (DHP) with venovenous bypass was evaluated in the elimination of anticancer drugs in hepatic artery infusion. Adriamycin (3 mg/kg) and mitomycin C (1 mg/kg) were given to mongrel dogs through the hepatic artery with three different durations of 1, 10, and 20 minutes. Plasma drug levels were determined at the inlet and outlet of DHP and right external jugular vein (systemic level). Blood flow through DHP averaged 200 ml/min. In dogs without DHP (group I; n = 4), systemic levels of adriamycin and mitomycin C increased rapidly with 1-minute infusion, reaching the peak values of 6.61 +/- 2.44 (mean +/- SD) and 2.20 +/- 1.05 micrograms/ml, respectively. With DHP under single venous bypass (group II; n = 5), the peak values were reduced to 1.25 +/- 1.02 and 0.79 +/- 0.52 microgram/ml. Moreover, the peak levels were markedly reduced by DHP under hepatic venous isolation (group III; n = 6), the values being 0.41 +/- 0.15 and 0.13 +/- 0.07 microgram/ml with 1-minute infusion. The drug-removal rates were improved substantially in group III compared with group II. The longer the duration of infusion, the higher the removal rates tended to be in group III. These results indicate that effective elimination of anticancer drugs can be accomplished by this system during intraarterial chemotherapy of the liver.

[Extracorporeal adriamycin-removal following hepatic artery infusion: use of direct hemoperfusion combined with veno-venous bypass]

Systemic toxicity of adriamycin (ADR) has limited its high dosage application in hepatic artery infusion. We developed a new extracorporeal device combining direct hemoperfusion (DHP) and veno-venous bypass to eliminate ADR following hepatic artery infusion. Mongrel dogs were divided into three group, I: controls without DHP (n = 3), II: DHP under single venous bypass from IVC to left external jugular vein (n = 3) and III: DHP under hepatic venous isolation using veno-venous bypass (n = 5). Blood specimens were obtained to determine plasma drug levels until 60 min after ADR injection (3 mg/kg body weight, 1 min). Blood flow through DHP, which was averaged 200 ml/min in both groups II and III, was monitored with ultrasonic flowmeter. In groups I and II, peripheral ADR levels rapidly increased, reaching the peak values of 5.61 +/- 2.42 and 1.17 +/- 0.31 micrograms/ml respectively at 1 min after injection. The peak level in group III was markedly reduced, the value being 0.42 +/- 0.17 microgram/ml, which was 7.5% of the peak value of group I. The removal rates in groups II and III were 10.9 and 27.5% respectively. In conclusion, DHP under hepatic venous isolation can be an useful method to reduce systemic distribution of ADR during hepatic artery infusion.

[Splenic vein occlusion due to pancreatic disease: regional portal hypertension from hemodynamic points of view]

The purpose of this study is to clarify the clinicopathophysiology of splenic vein occlusion due to pancreatic disease from hemodynamic points of view. We reviewed the angiographic findings and medical records of 82 patients who had pancreatitis, pancreatic cyst or pancreatic cancer in the pancreatic body and tail. According to the site of occlusion in 16 patients with complete splenic vein occlusion, this entity may be divided into two categories: Type A, an occlusion close to the spleen in which short-gastric system seems to be major collateral, and Type B, an occlusion distant from splenic hilum in which gastroepiploic system becomes prominent as collateral. As compared to 7 patients with incomplete splenic vein occlusion, gastric varices and splenomegaly were frequently observed with the patients having complete occlusion. Among these 16 patients, splenic arterial occlusion was superimposed in 3 patients with pancreatic cancer in whom gastric varices were not detected. Thus, clinical features of this entity must be carefully assessed according to the nature of the underlying disease. Based on these observations, three consecutive phases: Phase 1 Insiduous or latent phase, Phase 2 Collateral developing phase, Phase 3 Vanishing phase may be distinguished for splenic vein occlusion secondary to pancreatic disease.

Hemodynamic study of occlusion of the splenic vein caused by carcinoma of the pancreas

The most common cause of occlusion of the splenic vein is pancreatic disease, such as pancreatitis or carcinoma of the pancreas. As compared with benign causes, carcinoma of the pancreatic body or tail may readily involve not only the splenic vein, but also, eventually, the splenic artery. Therefore, the clinical features of occlusion of the splenic vein may be profoundly altered according to the nature of the underlying causes. In an attempt to clarify the pathophysiologic findings and hemodynamic mechanism of occlusion of the splenic vein associated with carcinoma of the pancreas, three patient reports were selected from our past experience. Upon analyzing the clinical course of these patients, three consecutive phases may be distinguished. Phase 1 is the insidious or latent phase represented by Patient No. 1. The splenic vein is partially occluded and gastric varices or splenomegaly has not developed. Phase 2, the collateral developing phase, is represented by Patient No. 2. The splenic vein is completely occluded while the splenic artery is patent, resulting in marked gastric varices and splenomegaly. Phase 3 is the vanishing phase and is represented by Patient No. 3. The occlusion of the splenic artery is superimposed on the occlusion of the splenic vein, causing gastric varices to vanish and the enlarged spleen to shrink.

Uptake, translocation, and transformation of pentachlorophenol in soybean and spinach plants

Soybean plants were grown for 90 days and spinach plants for 64 days in a mixture of sterilized greenhouse soil and sand containing 10 ppm pentachlorophenol. All plant parts and soil samples were extracted and separated into nonpolar and polar fractions. Major nonpolar and polar metabolites were identified by gas-liquid chromatography and mass spectrometry. Nonpolar fractions from both soybean and spinach plants were found to contain pentachlorophenol and its metabolites, 2,3,4,6-tetrachlorophenol, methoxytetrachlorophenol, 2,3,4,6-tetrachloroanisole, and pentachloroanisole. Cleavage of polar metabolites from the soybean plants by acid hydrolysis yielded organic solvent-extractable products. These products were identified as pentachlorophenol, 2,3,4,6-tetrachlorophenol, and methoxytetrachlorophenol. Cleavage of polar materials from spinach plants yielded only pentachlorophenol. The polar metabolites from the soybean plants were also subjected to enzymatic cleavage by beta-glucosidase. The conjugates consisted mostly of O-glucosides of the same metabolites released by acid hydrolysis. Failure of hydrolysis by aryl sulfatase indicated that very little or no sulfates were present. The metabolites found in the plants were not detected in soil samples obtained from pots immediately after the plants were harvested.

Screening of fresh water fish extracts for enzyme-inducing substances by an aryl hydrocarbon hydroxylase induction bioassay technique

A sensitive biological test to detect the presence of certain contaminants, such as highly toxic halogenated dioxins, dibenzofurans, and biphenyls in foods, was applied to extracts of fresh water fish that had been prepared by a food extraction-cleanup procedure developed by the Food and Drug Administration for pesticides and industrial chemicals. Aryl hydrocarbon hydroxylase (AHH) activity in a rat hepatoma cell line was used as the biological detection system for residues that induce enzyme activity. The induction of AHH activity by the extracts was compared with a standard AHH-induction curve for the most active compound known, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), and results were computed as TCDD equivalents. Several dilutions of fish extracts were used to produce AHH-induction curves from which an optimal dose-response range was determined and used to estimate TCDD equivalents. Cleaned-up extracts of fish obtained from different water bodies in the United States were examined for AHH activity. The samples which had low levels of polyhalogenated contaminants produced low biological activity, while a higher activity was obtained from fish that contained higher levels of polyhalogenated contaminants. The results suggest that the fish extracts can be screened for AHH inducers before chemical analysis.

Biodegradation of [ 14 C]Tri- p -Cresyl Phosphate in a Laboratory Activated-Sludge System

Biodegradation of [ 14 C]tri- p -cresyl phosphate was studied in a laboratory model sewage treatment system to develop information on the nature of its transformation products. In 24-h experiments, 70 to 80% of tri- p -cresyl phosphate added at the 1-μg/ml level was degraded. The remaining parent compound was associated with the sludge solids. The major metabolite extracted with ethyl ether from the aqueous phase was identified as p -hydroxybenzoic acid by gas chromatography-mass spectrometry. Two unstable ether-extractable metabolites were not identified. The half-life of [ 14 C]tri- p -cresyl phosphate was estimated to be 7.5 h.