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A subhepatic, whole auxiliary liver allotransplant technique, previously developed in the pig, was assessed for technical feasibility in 26 human cadaver transplants. All technical aspects of the subhepatic technique were feasible, with the exception of donor to recipient gallbladder-to-gallbladder anastomosis, which could only be performed in 50% of subjects due to excessive separation of the two gallbladders. To overcome the problem, an original technique was developed—namely, the use of an isolated, vascularized, isoperistaltic loop of jejunum to act as a conduit between donor and recipient gallbladders (cholecystojejunocholecystostomy). Cholecystojejunocholecystostomy was subsequently developed and studied in a series of live porcine auxiliary allografts. The local, regional, and general effects seen in 14 allografted pigs with cholecystojejunocholecystostomy were compared with those seen in a parallel and identical series of 14 allografts with cholecystocholecystostomy. The subhepatic transplantation technique is described in detail for the first time. Liver biopsies, blood samples, and clinical data were obtained at weekly intervals and at 28 days all survivors were killed.
Cholecystojejunocholecystostomy proved to be a successful method of biliary drainage in the pig. Thirteen of the 14 interposed jejunal loops were viable and essentially normal at autopsy, leaks and naked eye stasis were infrequent, and the histological incidence of intrahepatic cholangitis and cholestasis minimal. The local, regional, and general effects were comparable in every way with those obtained with cholecystocholecystostomy.
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- Another look at rejection in pig liver homografts.Surgery. 1974; 76: 617
- Specific bacteriologic problems after orthotopic liver transplantation in dogs and pigs.Arch Surg. 1968; 97: 313
- Observations on experimental and clinical liver transplantation.Transplant Proc. 1972; 4: 773
- A new technique for biliary drainage in orthotopic liver transplantation utilizing the gall bladder as a pedicle graft conduit between the donor and recipient common bile ducts.Ann Surg. 1976; 184: 605
- Orthotopic liver transplantation: the first 60 patients.Br Med J. 1977; 1: 471
- Pathology of orthotopic liver transplantation in pigs and dogs. Autopsy and biopsy studies.Ann Chir Gynaecol Fenniae. 1973; 62: 204
- A comparative study of two methods of biliary drainage in pigs subjected to auxiliary heterotopic hepatic transplantation.S Afr J Surg. 1975; 13 (abstract): 1
- Auxiliary liver allotransplantation—a human feasibility study, and an evaluation of a new technique in the pig.in: Master of Surgery Thesis. University of Cape Town, Dec 1978
- The natural history of liver allo- and autotransplantation in the pig.Br J Surg. 1971; 58: 407
- Allogeneic hepatic transplantation using cadaveric donors with clinical application.J Pediatr Surg. 1968; 3: 300
- Clinical liver heterotopic (auxiliary) transplantation.Surgery. 1973; 74: 739
- Infections in recipients of liver homografts.N Engl J Med. 1968; 279: 619
- Transhepatic metabolism after end-to-side portacaval shunt in the young pig.Surgery. 1974; 76: 601
- Liver transplantation in the pig.Med J Aust. 1970; 2: 261
- The avoidance of donor atrophy in auxiliary liver allotransplantation in the pig.in: Eur Soc Exp Surg 7th Congr. 1972: 288 (abstract)
- Heterotopic liver allotransplantation in the pig.in: Saunders SJ Terblanche J Liver. Pitman Medical, London1973: 210 (abstract)
- Hepatic sepsis after liver transplantation in dogs and pigs.Arch Pathol. 1969; 88: 166
- Delayed biliary duct obstruction after orthotopic liver transplantation.Surgery. 1972; 72: 604
- Liver transplantation in man. The significance, patterns, and control of infection.Br J Surg. 1970; 57: 280
- Bile duct blood supply. Its importance in human liver transplantation.Transplantation. 1978; 26: 67
- Auxiliary liver homotransplantation. A new technique and an evaluation of current techniques.Arch Surg. 1970; 100: 31
- Immunosuppression after experimental and clinical homotransplantation of the liver.Ann Surg. 1964; 160: 411
- Factors determining short- and long-term survival after orthotopic liver homotransplantation in the dog.Surgery. 1965; 58: 131
- Experience in hepatic transplantation.in: WB Saunders Co, Philadelphia1969: 41
- Autopsy findings in a long-surviving liver recipient.N Engl J Med. 1973; 289: 82
- Progress in and deterrents to orthotopic liver transplantation, with special reference to survival, resistance to hyperacute rejection, and biliary duct reconstruction.Transplant Proc. 1974; 6: 129
- Orthotopic liver transplantation in ninety-three patients.Surg Gynecol Obstet. 1976; 142: 487
- Biliary complications after liver transplantation:, with special reference to the biliary cast syndrome and techniques of secondary duct repair.Surgery. 1977; 81: 212
- Orthotopic autotransplantation and allotransplantation of the liver: functional and structural patterns in the dog.Ann Surg. 1967; 165: 325
- Orthotopic liver homotransplantation: an experimental study in the unmodified pig.S Afr Med J. 1968; 42: 486
- Homotransplantation of the canine liver. Survival and histology with and without azathioprine.Arch Surg. 1965; 90: 527
- Bile composition and bile cast formation after transplantation of the liver in man.Transplantation. 1975; 19: 382
- A method for the determination of glutamine in cerebrospinal fluid and the results in hepatic coma.J Clin Pathol. 1955; 8: 81
- Liver transplantation in man: the frequency of rejection, biliary tract complications, and recurrence of malignancy based on an analysis of 26 cases.Gastroenterology. 1973; 64: 1026
Accepted: September 13, 1979
☆Supported in part by the Medical Research Council of South Africa, the University of Cape Town Senate Research Committee, the Harry Crossley Foundation and the J. S. Marais Memorial Fund.
© 1980 Published by Elsevier Inc.