The shortage of liver grafts has resulted in an intensive search for alternative strategies of liver support in acute liver failure. Extracorporeal perfusion of pig livers (ECLP) is not a new concept, but recent improvements in cardiopulmonary bypass technology and new knowledge about xenogeneic immunologic mechanisms have made it a potential therapeutic modality. In previous suboptimal experimental and clinical models, no statements about the beneficial effect of long-lasting periods of ECLP were made. The aim of this study was to evaluate the capacity of pig liver for metabolic regeneration after xenogeneic ECLP under largely physiologic conditions. To delay hyperacute rejection (HAR), we utilized immunoadsorption (IA) of naturally preformed xenogeneic antibodies (XNAbs). This led to a stable xenogeneic ECLP for 45 min. However, IA was not able to prevent completely organ damage or loss of function resulting from insufficient autologous reperfusion. The inability to regenerate during autologous reperfusion provides a new measure of the function of a xenogeneic perfused pig liver. In addition, our results implicate that patients with fulminant liver failure will benefit from short perfusions with several fresh organs rather than from long perfusion with a single pig liver.
Due to growing shortage of donor organs, the concept of extracorporeal pig liver perfusion in the treatment of acute liver failure has been rediscovered. Immunomodulation, such as immunoapheresis or inhibition of complement, results in long-term perfusion without exact knowledge of the remaining metabolic graft viability. This study was aimed at the comparison of conventional parameters of graft stability such as perfusion rates and release of aminotransferases with parameters of metabolic graft function. Ig-Therasorb ® immunoapheresis (IA) of the xenogeneic perfusate was performed to protect the discordant pig livers from hyperacute rejection, mediated by preformed naturally occurring human xenogeneic antibodies. The application of IA created stable autologous graft reperfusion after a short time of xenoperfusion, but it was not able to prevent the livers from severe synthetic and functional damage. In the future, improvement of xenogeneic graft function, rather than pure prolongation of perfusion, must be the principal aim.
Congenital anomalies of the pericardium are extremely rare and often difficult to diagnose. We describe a 66-year-old woman presenting with multivessel coronary artery disease and right heart insufficiency complicated by an extremely left-rotated heart due to a congenital absence of left pericardium. A multidetector row computerized tomographic study was performed to evaluate the torsion of the heart as well as the physical relationship between the left internal thoracic artery and the left coronary system. Off-pump coronary surgery was scheduled. Both the operative and postoperative courses were uneventful and the patient was discharged after 11 days.
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