Replantation of the liver in dogs

Abstract 1. 1. The liver was replanted in 60 dogs: 37 survived longer than three days, 15 longer than one month. Three still survive at approximately 18 months, and one of these has delivered a litter of 12 puppies. The objective was to examine the effects of orthotopic autotransplantation as a prelude to the investigation of the immunological factors involved in orthotopic homotransplantation. 2. 2. Certain useful modifications of previously described liver transplantation techniques have been noted. The excised liver was perfused with cold solution without delay, but total body hypothermia was avoided. During replacement of the liver, the portal and caval blood was returned to the heart by means of a single external bypass from the caudal end of the divided portal vein to the external jugular vein, after the portal vein and infrahepatic vena cava had been temporarily joined by an autogenous vein graft. The arterial supply was restored by end-to-end anastomosis of the common hepatic artery. The incidence of vascular thrombosis was strikingly low. Anesthesia was achieved with repeated small intravenous doses of thiamylal sodium. 3. 3. Serum bilirubin levels remained normal in most animals. The blood glucose level frequently declined during the first postoperative day but then usually remained normal. The serum glutamic-oxalacetic transaminase level rose immediately in most animals but usually declined to normal after two weeks in chronic survivors. The serum alkaline phosphatase level rose within 48 hours following operation and usually declined in a few days, but in some instances it remained elevated for several months. 4. 4. The development of hepatic venous outflow block, abnormal bleeding, or subsequent ascites was rarely encountered when the organ had been well preserved with cold solution and trauma avoided by gentle handling. In contrast, when cold preservation was inferior or traumatic manipulation did occur, not only these complications but subsequent liver abscesses due to focal necrosis were observed. 5. 5. It is suggested that the results reported provide a description of the course of longterm survivors of canine liver replantation which was formerly lacking.