Personal experience with the procurement of 32 liver allografts.
OBJECTIVE
To introduce the American Pittsburgh's method of rapid liver procurement under the condition of brain death and factors influencing the quality of donor liver.


METHODS
To analyze 32 cases of allograft liver procurement retrospectively and observe the clinical outcome of orthotopic liver transplantation.


RESULTS
Average age of donors was 38.24+/-12.78 years, with a male:female ratio of 23:9. The causes of brain death included 21 cases of trauma (65.63%) and nine cases of cerebrovascular accident (28.13%). Fourteen grafts (43.75%) had hepatic arterial anomalies, seven cases only right hepatic arterial anomalies (21.88%), five cases only left hepatic arterial anomalies (15.63%) and two cases of both right and left hepatic arterial anomalies (6.25%) among them. Eight cases (57.14%) of hepatic arterial anomalies required arterial reconstruction prior to transplantation. Of the 32 grafts evaluated for early function, 27 (84.38%) functioned well, whereas three (9.38%) functioned poorly and two (6.25%) failed to function at all. Only one recipient died after transplantation and thirty-one recipients recovered. Four recipients needed retransplantation. The variables associated with less than optimal function of the graft consisted of donor age (35.6+/-12.9 years vs 54.1+/-4.3 years, P<0.05), duration of donor's stay in the intensive care unit (ICU) (3.5+/-2.4 d vs 7.4+/-2.1 d, P<0.005), abnormal graft appearance (19.0% vs 100%, P<0.05), and such recipient problems as vascular thromboses during or immediately following transplantation (89.3% vs 50.0%, P<0.005).


CONCLUSIONS
During liver procurement, complete heparization, perfusion in situ with localized low temperature and standard technique procedures are the basis ensuring the quality of the graft. The hepatic arterial anomalies should be taken care of to avoid injury. The donor age, duration of donor's staying in ICU, abnormal graft appearance and recipient problem are important factors influencing the quality of the liver graft.
Department of Surgery, Ruijin Hospital, Shanghai Second Medical University, Shanghai 200025, China. gw_vrai@yahoo.com.cn
Guang-Wen
GW
Zhou
Cheng-Hong
CH
Peng
Hong-Wei
HW
Li
D000293:Adolescent; D000328:Adult; D001926:Brain Death; D002648:Child; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014184:Transplantation, Homologous; D016896:Treatment Outcome