The Role of A-O-Incompatible Blood Transfusions in Porcine Orthotopic Liver Transplantations

Abstract

The consequences of administrations of A-O-incompatible blood transfusions during porcine orthotopic liver transplantations (OLT) are described. Two series, both subjected to the same standard procedure except for the administration of compatible or incompatible blood, are compared. The striking differences in peroperative and direct post-operative morbidity, mortality, and causes of death between the two series are presented. Although not generally applied, blood transfusions in experimental surgery should undergo the same precautionary measures as blood transfusions in humans.

Blood groups and transfusions in pigs

“…Hunfeld et al. [61] did a careful study, where they showed that pigs that received A–O incompatible transfusions developed pulmonary hypertension and decreased fibrinogen with an associated increase in fibrin degradation products. Eight of 15 pigs died during or shortly after surgery due to hemorrhage and four pigs died due to severe bronchospasm.…”

Extracorporeal isolated pig liver perfusion: Influence of various blood primes on liver function

“…Despite striking ameliorations in extracorporeal liver perfusion, including the use of silastic tubes, precision roller pumps, efficient blood filters, and the so-called pump circulation of the liver which allowed to simulate physiologic conditions, the function of the isolated liver is highly dependent on the blood used in the ECC. In the literature, this prime volume of 1,000-1,500ml (600ml in our study) has been obtained by various procedures [1,4,7]. Heterologous blood has shown to be inferior to homologous blood, especially in long-term perfusions [7].…”

“…In the literature, this prime volume of 1,000-1,500ml (600ml in our study) has been obtained by various procedures [1,4,7]. Heterologous blood has shown to be inferior to homologous blood, especially in long-term perfusions [7]. However, severe impairment of liver function due to genetic disparity was not observed [2].…”

“…However, severe impairment of liver function due to genetic disparity was not observed [2]. A-O incompatible homologous pig blood has shown to induce severe intravascular coagulation in liver transplantation in the pig [7]. Moreover, pig blood cannot be stored for a long period, because pig erythrocytes are unable to metabolize glucose and their energy source seems to be inosine [8].…”

“…Due to the easy access, heterologous human blood or homologous blood collected in the slaughterhouse were used by various groups [1,4,7]. Both of these perfusates are fraught with disadvantages.…”