Preserved vascular homograft for revascularization of pediatric liver transplant: a clinical, histological, and bacteriological study.
BACKGROUND
Arterial or venous homografts are frequently implanted for vascular reconstruction in orthotopic liver transplantation (OLT). When fresh vascular homografts (VH) from the same donor were not available, VH from another donor preserved at 4 degrees C in Terasaki (Ter) solution (modified lymphocyte culture medium) were used.


METHODS
The clinical results after implantation of Ter-stored VH versus fresh VH in the revascularization of pediatric OLT were studied retrospectively. Short- and long-term follow-up of vascular patency was carried out by doppler ultrasonography in each case. A histological and bacteriological study of nonimplanted VH stored at 4 degrees C in saline (Sal), Ter and University of Wisconsin (UW) solutions for various time periods (days 0-28) was also undertaken.


RESULTS
Between 1989 and 1996, 21 iliac arteries and 21 iliac veins preserved in Ter solution (mean preservation time: 8 days; range 1-26) and 100 fresh VH (68 arteries and 32 veins) (preservation time: 8 hr, range 4-21) were used in pediatric OLT. Thrombosis rates were 0 of 21 for stored arteries vs. 7 of 68 (10%) for fresh arteries (NS) and 3 of 21 (14%) for stored veins vs. 3 of 32 (9%) for fresh veins (NS). Actuarial graft survival rates were similar in both groups. Histological analysis of stored, nonimplanted VH invariably showed endothelial destruction within 24-48 hr after procurement. The bacteriological study showed contamination rates of 14 of 25 (56%) for Sal-stored VH, 5 of 25 (20%) for UW, and 1 of 19 (5%) for Ter (Sal vs. UW and Sal vs. Ter: P<0.01; UW vs. Ter: NS).


CONCLUSIONS
Ter-preserved cadaveric VH could be safely used in OLT despite early destruction of endothelium.
Martínez
J A
JA
Department of Pediatric Surgery, St-Luc University Clinics, Université Catholique de Louvain, Brussels, Belgium.
Rigamonti
W
W
Rahier
J
J
Gigi
J
J
Lerut
J
J
De Ville de Goyet
J
J
Otte
J B
JB
Reding
R
R
D000241:Adenosine; D000293:Adolescent; D000493:Allopurinol; D001419:Bacteria / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation; D004730:Endothelium, Vascular / Q000473:pathology; D005978:Glutathione; D006801:Humans; D007083:Iliac Artery / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology / Q000637:transplantation*; D007084:Iliac Vein / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology / Q000637:transplantation*; D007223:Infant; D007328:Insulin; D007552:Isotonic Solutions; D008099:Liver / Q000601:surgery*; D016031:Liver Transplantation; D019188:Organ Preservation Solutions; D011183:Postoperative Complications; D011887:Raffinose; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology; D014019:Tissue Donors; D014654:Vascular Patency
C033004:Collins-Terasaki solution; D007328:Insulin; D007552:Isotonic Solutions; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose