Since the first successful liver transplantation of the human was performed by Starzl at 1963, it has been developed with the advances of new surgical technique and the developments of transplantation immunology and become an elective, curative therapy for patient with irreversible liver diseases.
Experimental orthotopic liver transplantation is a very difficult procedure. And it is also difficult complex procedure which is composed with the donor liver preservation and procurement, and delicate stage of the recipient operation. Orthotopic liver transplantation involves such formidable metabolic difficulties that it requires continuous intraoperative and postoperative monitoring of electrolytes and other biochemical elements. As to the question whether intraoperative or postoperative enzyme determinations in serum after transplantation would contribute to prognosis, we compared the respective enzyme patterns of 10 long term survival animals which survived more than 1 week.
The liver has remarkable regenerative potential and the hepatic graft has beneficial immunological behavior compared with other organs. Recently, more attention has been paid to the fact that the liver itself is concerned at least in the process of stimulation for liver regeneration. Experimental liver transplantation in pigs has revealed that many animals retain a liver allograft for many months without any form of immunosuppression (Calne et al, 1967;Bockhorn et al, 1975;Garnier et al. 1979).
The present study was designed to investigate the regenerative potential and immunological unresponsiveness after liver transplantation in pigs. Orthotopic liver transplantation were performed in 10㎏ B.W. pig for donor and 20 to 25㎏ B.W. pig for recipient. I examined the immunological status by means of cell subpopulation analysis of lymphocytes in peripheral blood after transplantation with murine antiswine monoclonal antibodies PT4 and PT8.
1. I performed orthotopic liver transplantation without veno-venous bypass.The cold ischemic time was 75.2 minute and the period of anhepatic phase was 33.5 minute.
2. Because of the differentiation between the donor and recipient liver weight, it was very difficult to make vascular(esp., hepatic artery) and common bile duct anastomosis. I performed interrupted end-to-end anastomosis with 7-0 prolene suture material for hepatic artery.
3. Small liver, weighting 328.4g increased to 660.7g, 1 week and 650.2g, 2 weeks after liver transplantation. This suggests that the liver regeneration after transplantation was induced by volume replacement.
4. Severe hypolalemia developed in long surviving pigs during the early postoperative period, in spite of intravenous infusion of considerable amounts of potassium for several days. This may have been due to progressing destruction of liver cells, especially, cell membrane.
5. Immediately after liver transplantation, characteristic changes of the enzyme activities in the serum began and reached their maximum at day 1-2 and returned to normal after 5 days. Afterward, the enzyme pattern in serum developed according to the prevailing type of liver damage. But, due to overlaping of various liver damage, impending rejection was not detectable by means of enzyme determinations in serum.
6. After liver transplantation, the lymphocyte in peripheral blood reacted to monoclonal antibody PT4 and PT8. The ratio of PT4/PT8 was decreased from 1.39 in normal control. Moreover, suppressor /cytotoxic T-lymphocyte increased more than helper T-cells. This quantitative changes of lymphocytes might mean that the liver it-self after transplantation had immunosuppressive potential by activating suppressor T-cell.
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