title: Single vs. dual vessel porcine extracorporeal liver perfusion.
abstract: BACKGROUND
  The use of porcine extracorporeal liver perfusion (PECLP) to provide temporary hepatic support for patients in fulminant hepatic failure has been limited by the fact that individual perfusions can be sustained for only a few hours. Inadequate liver function and/or hemodynamic instability are the major contributing factors for early interruption of PECLP. Recent reports suggest that the choice of single (portal vein only) vs dual (portal vein and hepatic artery) vessel perfusion may influence the duration of perfusion. We hypothesize that PECLP with single vessel perfusion (SVP) is associated with worse liver function and greater hemodynamic instability than PECLP with dual vessel perfusion (DVP).
  
  
  METHODS
  To eliminate the potentially confounding influences of liver failure and xenograft rejection, liver isografts procured from White-Landrace pig donors were perfused by either SVP or DVP via an extracorporeal circuit established with normal White-Landrace pig recipients. The function of perfused livers was evaluated by measuring production of bile and Factors V and VIII, clearance of ammonia and lactate, and extraction of O(2) at baseline and at 0, 1, 3, 6, 12, and 24 h after initiation of PECLP. The impact of PECLP on recipient hemodynamic status was assessed by monitoring BP, heart rate, urine output, O(2) saturation, etc. Among other parameters evaluated were serum albumin and total protein and hepatic release of IL-1beta and nitric oxide to assess their possible contributions to hemodynamic instability.
  
  
  RESULTS
  DVP and SVP livers cleared ammonia and lactate similarly. Both approaches were associated with progressive hypoalbuminemia and hypoproteinemia. DVP livers produced more bile and Factor V and were associated with less recipient hypotension and IL-1beta and NO release than SVP livers.
  
  
  CONCLUSIONS
  Livers with DVP function better than livers with SVP. The duration of PECLP can be limited by recipient hypotension, although this complication is less severe with DVP than with SVP.
authors.affiliation: Northwestern University Medical School, Chicago, Illinois, 60611-2923, USA.
authors.forename: N
authors.initials: N
authors.lastname: Mora
authors.forename: L
authors.initials: L
authors.lastname: Kaptanoglu
authors.forename: Z
authors.initials: Z
authors.lastname: Zhang
authors.forename: Marek
authors.initials: M
authors.lastname: Niekrasz
authors.forename: S
authors.initials: S
authors.lastname: Black
authors.forename: K
authors.initials: K
authors.lastname: Ver Steeg
authors.forename: R
authors.initials: R
authors.lastname: Wade
authors.forename: V
authors.initials: V
authors.lastname: Siddall
authors.forename: W
authors.initials: W
authors.lastname: Pao
authors.forename: W
authors.initials: W
authors.lastname: Walsh
authors.forename: D
authors.initials: D
authors.lastname: Ivancic
authors.forename: D
authors.initials: D
authors.lastname: Kaufman
authors.forename: M
authors.initials: M
authors.lastname: Abecassis
authors.forename: F
authors.initials: F
authors.lastname: Stuart
authors.forename: A
authors.initials: A
authors.lastname: Blei
authors.forename: J
authors.initials: J
authors.lastname: Leventhal
authors.forename: J
authors.initials: J
authors.lastname: Fryer
mesh_terms: D000641:Ammonia / Q000378:metabolism; D000818:Animals; D001646:Bile / Q000502:physiology; D001794:Blood Pressure; D004231:Diuresis; D005112:Extracorporeal Circulation / Q000379:methods*; D005165:Factor V / Q000096:biosynthesis; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006499:Hepatic Artery; D007022:Hypotension / Q000209:etiology; D019344:Lactic Acid / Q000378:metabolism; D008099:Liver / Q000098:blood supply* / Q000502:physiology; D017093:Liver Failure / Q000628:therapy; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption; D011169:Portal Vein; D013552:Swine; D013925:Thromboplastin / Q000096:biosynthesis
chemical_list: D019344:Lactic Acid; D000641:Ammonia; D005165:Factor V; D013925:Thromboplastin; D010100:Oxygen