Orthotopic Autotransplantation and Allotransplantation of the Liver

Abstract

Azathioprine was given to 6 normal dogs and caused only minor adverse effects on the liver. A method of ortho-topic hepatic allotransplantation in dogs was described. The central features are a temporary "Y" shunt for hepatic venous bypass and anastomosis of the recipient renal artery to the donor celiac artery. Hepatic autotransplantation using a modification of the allotransplantation procedure was performed on 4 dogs. Only minor functional and structural changes were observed in the autotransplanted livers. Orthotopic allotransplantation of the liver was performed on 52 dogs. Four immunosuppressive protocols were tested. The first, actinomycin-C alone, did not prolong graft survival. Three protocols using various combinations of azathioprine, actinomycin-C and local X-irradiation of the liver were equally effective in their modest ability to prolong graft survival. Six dogs survived more than 50 days, and the longest survivor lived 88 days. All 6 dogs were undergoing slow hepatic rejection and had upper gastro-intestinal ulceration at the time of death. Massive bleeding from upper gastro-intestinal ulcers was the immediate cause of death in 5 of the 6 dogs. Ulceration was prevented by subtotal gastric resection but not by vagotomy and pyloroplasty. The ulceration may be acid-peptic in nature and may be due to an humoral mechanism associated with hepatic rejection.