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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 1999 June;40(3):347-53

lingua: Inglese

Multiple ­organ har­vest­ing from a sin­gle ­donor for trans­plan­ta­tion. A com­par­i­son of sim­ple cool­ing tech­nique and ­bypass tech­nique

Takahashi T., Morishita Y., Ichikawa H., Sato Y., Suzuki M., Ohya T., Tomisawa N.

From the Second Department of Surgery Gunma University School of Medicine, Maebashi, Japan


Background. We com­pared a sim­ple, cool­ing tech­nique to a car­di­o­pul­mo­nary ­bypass (CPB) tech­nique for mul­ti­ple ­organ har­vest­ing (MOH) ­from a sin­gle ­donor. Methods. Adult mon­grel ­dogs ­were divid­ed ­into ­three ­groups. In the in ­situ cool­ing ­group, the aor­ta and IVC ­were ­first ­clamped and the hepat­ic and ­renal vas­cu­lar ­beds ­were ­washed out ­with a ­cold lac­tat­ed Ringer’s solu­tion. In the per­i­to­neal cool­ing ­group, hypo­ther­mia was ­induced ­using an ice ­slush in the abdom­i­nal cav­ity, and in the CPB ­group ­using CPB . As the esoph­a­geal tem­per­a­ture ­reached 25°C, the liv­er and kid­neys ­were har­vest­ed ­using the ­same pro­ce­dure in all ­three ­groups. After the splanch­nic per­fu­sion, the ­heart was har­vest­ed ­while it con­tin­ued to ­beat. The ­heart was pre­served for 12 ­hours, and the liv­er and kid­neys for 24 ­hours in a ­cold UW solu­tion. Myocardial ­high-ener­gy phos­phates ­were meas­ured ­using 31P-MRS, and the ­hearts ­were trans­plant­ed. Hepatic vas­cu­lar ­beds ­were ­flushed dur­ing pre-s­er­va­tion, and the efflu­ent was ana­lyzed. Following kid­ney trans­plan­ta­tion, its func­tion was meas­ured.
Results. There’s no sig­nif­i­cant dif­fer­ence in myo­car­dial ­high-ener­gy phos­phate or in car­diac func­tion ­after trans­plan­ta­tion. During liv­er pres­er­va­tion, ALT and LDH lev­els of the efflu­ent ­were sig­nif­i­cant­ly high­er in the in ­situ ­group ­than ­those in oth­er ­groups. There’s no dif­fer­ence fol­low­ing kid­ney trans­plan­ta­tion.
Conclusion. The CPB meth­od and per­i­to­neal cool­ing tech­nique dem­on­strat­ed strong­er ear­ly func­tion of hepat­ic ­grafts com­pared ­with the in ­situ cool­ing meth­od. The per­i­to­neal cool­ing tech­nique is a sim­pler, saf­er and ­more fea­sible alter­na­tive for MOH com­pared ­with CPB meth­od, and it may ­have ­broad clin­i­cal appli­ca­tion.

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