Metabolische funktion und regenerationsfahigkeit der xenogen perfundierten schweineleber: Beurteilung der organfunktion wahrend autologer reperfusion

Due to organ shortage, about 20% of patients with fulminant hepatic failure are dying on the waiting list for liver transplantation. Apart from other liver assist devices, extracorporeal pig liver perfusion could develop to an useful therapeutical alternative. There exist several reports about xenogeneic long-term perfusions of pig livers using medical or immunological manipulation. However, there is still obscurity about the therapeutical value of such a long-term perfusion for patients. For further evaluation of the impact of xenogeneic perfusion on the graft's function, we designed a new experimental concept. We considered the pig liver's capability and ability of metabolic regeneration during autologous reperfusion as a very valid parameter of its remaining function after xenogeneic perfusion. In an ex- vivo perfusion model the xenogeneic perfused organs (n=6) were not able to regenerate during autologous reperfusion, in comparison to autologous perfused pig livers (n=6). On the contrary, the pig livers were suffering from irreversible progressive functional organ damage despite autologous reperfusion. These results indicate that patients with fulminant hepatic failure rather benefit from serial short time perfusions of several organs than from long-term perfusion of one pig liver. Improvements concerning perfusion technique and the application of immunmodulation will contribute to a better prognosis for the patient with hepatic failure.