Ex situ Operation an der Leber Eine neue M�glichkeit in der Leberchirurgie

Pichlmayr, R.; Bretschneider, H. J.; Kirchner, E; Ringe, B; Lamesch, P.; Gubernatis, G.; Hauß, J.; Niehaus, K. J.; Kaukemüller, J.

doi:10.1007/bf01262775

Cited by 125 publications

(48 citation statements)

References 6 publications

(4 reference statements)

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“…Only the hepatocytes of normothermic control livers (biopsy samples) were 10% larger than hepatocytes of cold flushed groups. None of the protective perfusion protocols showed structural signs of perfusion injury.Today several perfusion methods are available which differ markedly as to the principles of the solution-composition and consequently to the recommended dosage and perfusion technique [8,18,21,28]. With all protective solutions the content of the extracellular space is changed more or less fundamentally.…”

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confidence: 99%

Morphological investigation of the porcine liver directly following preservation with Euro-Collins, University of Wisconsin and Bretschneider's HTK solution

Aminalai

Kehrer²,

Grossmann³

et al. 1992

Langenbecks Arch Chir

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In order to study perfusion effects of different liver preservation methods on liver structure, porcine livers were perfused with either Bretschneider's HTK (Histidine Tryptophane Ketoglutarat) solution, Euro-Collins (EC) solution or University of Wisconsin solution (UW) according to the respective recommended protocols. Subsequently, together with a group of unprotected livers, all organs were examined by light and electron microscopy including computer assisted morphometry. The width of the space of Disse, the continuity of endothelial cells and the ultrastructure of the hepatocytes were not impaired after cold perfusion with any of the 3 solutions. However, we found considerable differences between the groups with respect to removal of blood cells from liver sinusoids. Livers flushed according to the HTK-protocol had the lowest residual blood cell content followed by the livers of the EC- and the UW-group. Centrilobular regions of the liver lobules were generally better washed free of blood than periportal zones. Computer assisted morphometry did not reveal any significant difference between the size of hepatocytes of EC-, UW- and HTK livers. Only the hepatocytes of normothermic control livers (biopsy samples) were 10% larger than hepatocytes of cold flushed groups. None of the protective perfusion protocols showed structural signs of perfusion injury.

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mentioning

confidence: 99%

Morphological investigation of the porcine liver directly following preservation with Euro-Collins, University of Wisconsin and Bretschneider's HTK solution

Aminalai

Kehrer²,

Grossmann³

et al. 1992

Langenbecks Arch Chir

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“…In den ersten klinischen Anwendungen einer hypothermen In-situ-Protektion der Leber waren die Temperaturverluste bei g/jnstigerem K6rperoberfl/ichen/K6rpervolumenverh/iltnis weniger ausgepr/igt; eine aktive Temperaturzufuhr war hier nicht notwendig [26,27].…”

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In-situ-Protektion der Leber mit der HTK-L�sung nach Bretschneider

Lamesch

Raygrotzki

Kehrer

et al. 1991

Langenbecks Arch Chiv

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Liver resections are usually performed under occlusion of the hepatoduodenal ligament (Pringle manoeuvre) in order to limit operative blood loss. The maximal ischemic tolerance, although individually different, is generally accepted to be 60 min. Resections of centrally located tumors require precise preparation, sometimes combined with vascular reconstructions. In such cases a prolonged ischemic time is inevitable. A save prolongation of the ischemic tolerance could be useful for extensive liver resections. In an experimental study in pigs ischemic tolerance of the liver was studied under hypothermic protection with the HTK solution of Bretschneider during 2 and 3 h. Deterioration of liver function was compared with a warm ischemia during 2 h. Results showed significantly less serum transaminase activities and better hepatic blood flow (ICG test) after an ischemia under protection with the HTK solution compared to a warm ischemia during 2 h. A prolonged ischemia during 3 h under protection with the HTK solution was well tolerated. First clinical applications of hypothermic hepatic protection during resection were successful.

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“…Dieser Puffer bewirkt auch zusammen mit Mannitol die osmotische Balance. Erste klinische Erfahrungen mit der Leberkonservierung zum Zweck der Ex-situ-Resektion und zur Lebertransplantation liegen vor und zeigen gute Ergebnisse mit Konservierungszeiten von bis zu 12,5 h [9,15]. Auch hier ist das Problem der initialen Nichtfunktion nicht mehr relevant.…”

Section: Diskussionunclassified

Prim�re hepatozytenkulturen als modell zur experimentellen untersuchung der leberkonservierung

Viebahn¹,

Groot

Lauchart

et al. 1991

Langenbecks Arch Chir

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Primary hepatocyte cultures have been used to evaluate data concerning hypoxic liver cell injury. To show the suitability of this method in liver preservation studies hepatocyte cultures were incubated under different conditions: warm normoxia (37 degrees C, pO2 greater than 70 mm Hg), warm hypoxia (37 degrees C, pO2 less than 0.1 mm Hg), cold normoxia (4 degrees C, pO2 greater than 70 mm Hg) and cold hypoxia (4 degrees C, pO2 less than 0.1 mm Hg). Incubations were performed in Euro Collins solution (EC), University of Wisconsin solution of Belzer (UW) and histidine ketoglutarat tryptophan solution of Bretschneider (HTK) as well as in Krebs Henseleit buffer (KH) for control incubations. During 12 h of incubation hepatocyte cultures under warm normoxia lost viability continuously in EC, UW and HTK while in KH they remained stable. Under warm normoxia all cultures lost 50% of their viability during 12 h of incubation while in cold normoxia loss of viability was mild but significant. Under cold anoxia which is the standard condition of liver preservation the cultured hepatocytes remained unchanged for 12 h in KH, UW and HTK, while in EC most of the cells were dead after 6 h. It is concluded that incubations of primary hepatocyte cultures under different pO2 and temperatures are well suited to contribute to liver preservation studies on a preclinical level and thus may help to save animal experiments.

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Ex situ Operation an der Leber Eine neue M�glichkeit in der Leberchirurgie

Cited by 125 publications

References 6 publications

Morphological investigation of the porcine liver directly following preservation with Euro-Collins, University of Wisconsin and Bretschneider's HTK solution

Morphological investigation of the porcine liver directly following preservation with Euro-Collins, University of Wisconsin and Bretschneider's HTK solution

In-situ-Protektion der Leber mit der HTK-L�sung nach Bretschneider

Prim�re hepatozytenkulturen als modell zur experimentellen untersuchung der leberkonservierung

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