J Korean Soc Transplant.  2015 Sep;29(3):109-117. 10.4285/jkstn.2015.29.3.109.

Liver Procurement

Affiliations
  • 1Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 2Department of Surgery, Seoul National University Hospital, Seoul, Korea. kwleegs@gmail.com
  • 3Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

Abstract

With increasing demand for liver transplantation, liver grafts are used from marginal donors who were not considered suitable. This trend toward the use of marginal donors reinforces the need to balance the recipient's condition and graft quality and to perform a liver retrieval process with a proper method for preservation of liver function. Although the issues in organ procurement are debatable, rapid and high pressure perfusion for the aorta only with a cold dissection method can be an optimal method for the successful recipient outcome in liver transplantation using a marginal graft.

Keyword

Liver transplantation; Organ procurement; Organ donor

MeSH Terms

Aorta
Humans
Liver Transplantation
Liver*
Perfusion
Tissue and Organ Procurement
Tissue Donors
Transplants

Figure

  • Fig. 1. Yearly distribution of deceased donor age. Adapted from Table 1–2–2 of reference [1].

  • Fig. 2. Thoracoabdominal incision. A complete midline incision is performed from the suprasternal notch to the pubis.

  • Fig. 3. Liver mobilization and Kocherization. (A) Ligamentum venosum was identified, (B) Dissection of the right paracolic gutter, (C) Inferior vena cava exposure after Kocherizaiton.

  • Fig. 4. Preparation for cannulation.(A) The inferior mesenteric vein was encircled, (B) Abdominal aorta encircled with 1∼0 Nylon, (C) Lumbar artery was identified and ligated, (D) Inferior vena cava was dissected with a blunt right angle clamp, (E) The supraceliac aorta was palpable and right crus muscle was dissected, (F) The aorta was exposed.

  • Fig. 5. Catheterizations and rapid cooling. (A) Inferior mesenteric vein was cannulated, (B) The distal aorta was ligated and proximal abdominal aorta was clamped before cannulation, (C) Rapid cooling of thoracoabdominal organs after the aorta cross-clamping and preservation solution infusion.

  • Fig. 6. Gallbladder irrigation. Gallbladder irrigation with cold saline after rapid cooling.

  • Fig. 7. Liver harvesting. (A) Gastroduodenal artery was identified, (B) Superior mesenteric vein was resected and a catheter from inferior mesenteric vein was located in the vessel lumen, (C) Common bile duct was resected and bile should be irrigated, (D) Celiac axis was resected with aortic patch, (E) Diaphragm dissection after putting a index finger into inferior vena cava,(F) Intrahepatic inferior vena cava was dissected and resected above the orifice of renal vein.


Cited by  1 articles

Organ procurement in a deceased donor
Hong Pil Hwang, Jong Man Kim, Sung Shin, Hyung Joon Ahn, Sik Lee, Dong Jin Joo, Seung Yeup Han, Seok Jin Haam, Jeong Kye Hwang, Hee Chul Yu
Korean J Transplant. 2020;34(3):134-150.    doi: 10.4285/kjt.2020.34.3.134.


Reference

References

1). Ministry of Health & Welfare, Korean Network for Organ Shering. 2014 Konos Annual Report. Seoul: KONOS; 2015. (보건복지부 질병관리본부 장기이식관리센터. 장기이식 통계연보, 2014. 서울: 질병관리본부 장기이식관리센터: 질병관리본부 장기이식관리센터;2015. .).
2). Yu HC, Cho BH. How to Do I Make an Organ Procurement in Deceased Donor? J Korean Soc Transplant. 2006; 20:14–24. (유희철, 조백환. 뇌사자에서의 장기구득 방법. 대한이식학회지 2006;20: 14–24.).
3). Chapman WC, Vachharajani N, Collins KM, Garonzik-Wang J, Park Y, Wellen JR, et al. Donor age-based analysis of liver transplantation outcomes: short- and longterm outcomes are similar regardless of donor age. J Am Coll Surg. 2015; 221:59–69.
Article
4). Darius T, Monbaliu D, Jochmans I, Meurisse N, Desschans B, Coosemans W, et al. Septuagenarian and octogenarian donors provide excellent liver grafts for transplantation. Transplant Proc. 2012; 44:2861–7.
Article
5). Goldaracena N, Quiñ onez E, Mé ndez P, Anders M, Orozco Ganem F, Mastai R, et al. Extremely marginal liver grafts from deceased donors have outcome similar to ideal grafts. Transplant Proc. 2012; 44:2219–22.
Article
6). Starzl TE, Hakala TR, Shaw BW Jr, Hardesty RL, Rosenthal TJ, Griffith BP, et al. A flexible procedure for multiple cadaveric organ procurement. Surg Gynecol Obstet. 1984; 158:223–30.
Article
7). Margreiter R, Kö nigsrainer A, Schmid T, Takahashi N, Pernthaler H, Ofner D. Multiple organ procurement–a simple and safe procedure. Transplant Proc. 1991; 23:2307–8.
8). Brockmann JG, Vaidya A, Reddy S, Friend PJ. Retrieval of abdominal organs for transplantation. Br J Surg. 2006; 93:133–46.
Article
9). Starzl TE, Miller C, Broznick B, Makowka L. An improved technique for multiple organ harvesting. Surg Gynecol Obstet. 1987; 165:343–8.
10). Klar E, Kraus T, Osswald BR, Bleyl J, Fernandes L, Mehrabi A, et al. Induction of impaired hepatic microcirculation by in situ hilus preparation in liver explantation. Zentralbl Chir. 1995; 120:482–5.
11). Schemmer P, Enomoto N, Bradford BU, Bunzendahl H, Raleigh JA, Lemasters JJ, et al. Activated Kupffer cells cause a hypermetabolic state after gentle in situ manipulation of liver in rats. Am J Physiol Gastrointest Liver Physiol. 2001; 280:G1076–82.
Article
12). Jung DH, Hwang S, Ahn CS, Kim KH, Moon DB, Ha TY, et al. Safety and usefulness of warm dissection technique during liver graft retrieval from deceased donors. Transplant Proc. 2015; 47:576–9.
Article
13). Emond JC, Freeman RB Jr, Renz JF, Yersiz H, Rogiers X, Busuttil RW. Optimizing the use of donated cadaver livers: analysis and policy development to increase the application of split-liver transplantation. Liver Transpl. 2002; 8:863–72.
Article
14). Noujaim HM, Gunson B, Mayer DA, Mirza DF, Buckels JA, Candinas D, et al. Worth continuing doing ex situ liver graft splitting? A singlecenter analysis. Am J Transplant. 2003; 3:318–23.
Article
15). Hong JC, Yersiz H, Busuttil RW. Where are we today in split liver transplantation? Curr Opin Organ Transplant. 2011; 16:269–73.
16). Abu-Elmagd K, Fung J, Bueno J, Martin D, Madariaga JR, Mazariegos G, et al. Logistics and technique for procurement of intestinal, pancreatic, and hepatic grafts from the same donor. Ann Surg. 2000; 232:680–7.
Article
17). Nakazato PZ, Concepcion W, Bry W, Limm W, Tokunaga Y, Itasaka H, et al. Total abdominal evisceration: an en bloc technique for abdominal organ harvesting. Surgery. 1992; 111:37–47.
18). Filipponi F, Oleggini M, Romagnoli P, Fossati N, Pardini P, Mosca F. Exclusively aortic cold flushing for liver procurement from hemodynamically stable donors. An experimental study in the pig. G Chir. 1996; 17:59–63.
19). Gä bel M, Lidé n H, Norrby J, Friman S, Wolfbrandt A, Olausson M. Early function of liver grafts preserved with or without portal perfusion. Transplant Proc. 2001; 33:2527–8.
20). de Ville de Goyet J, Hausleithner V, Malaise J, Reding R, Lerut J, Jamart J, et al. Liver procurement without in situ portal perfusion. A safe procedure for more flexible multiple organ harvesting. Transplantation. 1994; 57:1328–32.
21). Iaria G, Tisone G, Pisani F, Buonomo O, Camplone C, Pollicita S, et al. High-pressure perfusion versus gravity perfusion in liver harvesting: results from a prospective randomized study. Transplant Proc. 2001; 33:957–8.
Article
22). Tokunaga Y, Ozaki N, Wakashiro S, Ikai I, Kimoto M, Morimoto T, et al. Effects of perfusion pressure during flushing on the viability of the procured liver using noninvasive fluorometry. Transplantation. 1988; 45:1031–5.
Article
23). Moench C, Moench K, Lohse AW, Thies J, Otto G. Prevention of ischemic-type biliary lesions by arterial back-table pressure perfusion. Liver Transpl. 2003; 9:285–9.
Article
24). Blumhardt G, Lemmens P, Topalidis T, Meissler M, Baer P, Steffen R, et al. Increased flow rate of preservation solution in the hepatic artery during organ preservation can improve postischemic liver function. Transplant Proc. 1993; 25:2540–2.
25). Komokata T, Nishida S, Ogata S, Hamada N, Ikoma A, Tanaka K, et al. Influence of the flow rate during flushing on porcine multivisceral preservation. In Vivo. 1998; 12:245–51.
Full Text Links
  • JKSTN
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr