Beneficial Effects of Combined Use of Extracorporeal Membrane Oxygenation and Hypothermic Machine Perfusion in Porcine Donors after Cardiac Death for Liver Transplantation.

Grafts from donors after cardiac death (DCD) have greatly contributed to expanding the donor organ pool. This study aimed to determine the benefits of subnormothermic extracorporeal membrane oxygenation (ECMO) and hypothermic machine perfusion (HMP) in a porcine model of DCD liver. Female domestic crossbred Large Yorkshire and Landrace pigs weighing approximately 20 kg were used. The abdominal aorta and inferior vena cava were cannulated and connected to an ECMO circuit for in situ perfusion of the abdominal organs at 22 °C for 60 min, 45 min after cardiac death. The pigs were divided into the cold storage (CS) group (n = 3), where liver grafts were preserved at 4 °C, and the HMP group (n = 3), where liver grafts were preserved by HMP at 8-10 °C. After 4 h of preservation, liver function was evaluated using an isolated liver reperfusion model for 2 h. Although the difference was insignificant, the liver effluent enzyme levels in the HMP group were lower than those in the CS group. Furthermore, morphological findings showed fewer injured hepatocytes in the HMP group than in the CS group. The combined use of in situ subnormothermic ECMO and HMP was beneficial for the functional improvement of DCD liver grafts.

Combined Use of Subnormothermic Extracorporeal Support and Hypothermic Oxygenated Machine Perfusion for Liver Graft After Cardiac Death in Pigs.

BACKGROUND: The use of grafts from donors after cardiac death (DCD) would greatly contribute to the expansion of the donor organ pool. This study aims to determine the benefits of extracorporeal membrane oxygenation (ECMO) and hypothermic oxygenated machine perfusion (HOPE) in a large animal model of DCD liver. METHODS: After cardiac arrest, the abdominal aorta and the inferior vena cava were cannulated and connected to an ECMO circuit. Porcine livers were perfused in situ with ECMO at 22°C for 60 minutes after 45 minutes of cardiac death. Then, the livers were perfused for 4 hours by cold storage (CS) or HOPE. In group 1, non-in situ ECMO and grafts were preserved by HOPE. In group 2, in situ ECMO and grafts were preserved by HOPE. In group 3, in situ ECMO and grafts were preserved by CS. After preservation, all grafts were evaluated using an isolated reperfusion model (IRM) with autologous blood for 2 hours. RESULTS: During HOPE, aspartate aminotransferase (AST) levels and hepatic arterial pressure in group 2 tended to be lower than in group 1. Hematoxylin-eosin staining findings after HOPE showed more massive sinusoidal congestion and hepatocyte cytoplasmic vacuolization in group 1 than in group 2. The AST and LDH levels in group 2 at the start-up of IRM tended to be lower than in group 1. CONCLUSIONS: The combined use of in situ subnormothermic ECMO and HOPE is essential for the functional recovery of DCD liver grafts.

Combined Surgical, Radiation, and Medical Therapies for Osteochondrodysplasia in a Scottish Fold Cat.

Osteochondrodysplasia affects both homozygous and heterozygous Scottish Fold cats, and various treatments have been attempted to control chronic pain and improve mobility in these animals. However, to date, there is no single effective treatment that can be used to treat all cats with Scottish Fold osteochondrodysplasia (SFOCD). A 4 yr old castrated Scottish Fold cat presented with plantar exostoses in the right hindlimb, the largest of which was caudal to the tarsometatarsal joint and had stretched the overlying skin, causing ulceration and bleeding. There was right hindlimb lameness. The cat was diagnosed with SFOCD, and the skin lesions were treated by excision of the exostoses, removal of the damaged skin, and wound closure. All extremities were treated with radiotherapy and subcutaneous pentosan polysulfate for chronic pain. The cat's gait improved after surgery, and increased activity was noted after radiotherapy. There were no signs of excessive bone proliferation or adverse effects at 80 wk postoperatively. In conclusion, a combination of surgical, radiation, and medical therapies could be an effective treatment strategy for SFOCD with skin ulceration.

Initial perfusate purification during subnormothermic machine perfusion for porcine liver donated after cardiac death.

Improvement of machine perfusion (MP) technologies is required to enhance organ quality for donor after cardiac death (DCD) grafts. Installing a dialyzer or a filter into the perfusion circuit to maintain the perfusate condition has some advantages. However, the consequences of purification perfusate during subnormothermic machine perfusion (SNMP) remain unexplained. In this study, the effects of initial purification perfusate with simple method of replacing the first 0.5-L perfusate during SNMP were investigated to consider installation effect of the filter or the dialyzer. Porcine liver grafts, which have 60-min warm ischemia time, were procured to imitate the DCD graft condition. Purified SNMP (PSNMP) results were compared with simple cold storage and conventional SNMP. In PSNMP, initial perfusate of 0.5 L was removed to substitute for purification. After preservation process, the preserved grafts were reperfused with diluted autologous blood for 2 h under normothermic machine perfusion condition to evaluate the liver function using an isolated reperfusion model. The vascular pressures, enzyme release rates and the metabolic indexes during reperfusion were analyzed. The pressures in the hepatic artery after reperfusion 60 min were significantly lower in PSNMP group compared with cold storage (CS) and SNMP groups. In addition, lactate dehydrogenase and alkaline phosphatase were significantly lower after PSNMP than after the CS or SNMP. Also, the metabolic indexes of hyaluronic acid and lactate were significantly decreased by purifying the perfusate in MP preservation than in CS or SNMP. The effectiveness of initial purification perfusate during SNMP was investigated.

Short-term effects of arthrotomy with and without infrapatellar fat pad resection on the normal canine stifle.

OBJECTIVE: To investigate the short-term effects of infrapatellar fat pad (IFP) resection in normal dogs. STUDY DESIGN: Experimental in vivo study. ANIMALS: Five normal adult female beagle dogs. METHODS: The IFP was resected via arthrotomy in the left stifle joint (experimental side) while the right stifle underwent arthrotomy alone (sham side). An orthopedic examination was performed every week for 4 weeks and synovial fluid was analyzed before and 4 weeks after the procedure. The ratio of the length of the patellar ligament to the patellar length (L:P) was calculated on a lateral radiograph of the stifle before, 2 and 4 weeks after the procedure. Patellar depth (PD) and the contact area (CA) between the femur and patella were calculated from computed tomographic images taken at 3 different stifle angles (extended, flexed, hyperflexed) before, immediately after, and 4 weeks following the procedure. The dogs were euthanatized 4 weeks after the procedure for macroscopic and microscopic evaluation of the patellofemoral joint. RESULTS: No difference was found between treatment groups throughout the study. No evidence of postoperative osteoarthritis was detected in any of the dogs. Orthopedic examinations, radiographs, and synovial fluid analyses remained within normal limits. Most PD, but not CA measurements, increased with time in both joints and at all stifle angles. CONCLUSIONS: Excision of the IFP subsequent to medial arthrotomy did not result in any measurable changes in the canine patellofemoral joint when compared with medial arthrotomy alone after 4 weeks of follow-up.