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Despite ethical problems, the advantages of the domino procedure are obvious: (1) expansion of the donor pool, (2) ability to use living donors, and (3) presence of very short ischemic time and thus excellent liver function. Due to the kinetics of TTR production and deposition, donors and recipients of FAP livers should be followed up using an extensive neurological and cardiological protocol.

The study was designed to concentrations were significantly assess the gastrointestinal ischaemia lower in the pretreated group and the influence of the specific [39 f 23 pg/ml (Control): 14 f 7 Kupffer cell toxin gadolinium chlo-(GdCI,); P < 0.051 suggesting an imride (GdC1,) on the hepatic and ex-proved liver LPS clearance [86% 051. The anhepatic phase in-24 h before explantation, while con-duced splanchnic ischaemia which trols (n = 8) received normal saline. correlated with portal endotoxaGastric and sigrnoid intramucosal emia. Donor preconditioning with pH (pHi), LPS and endotoxin-neu-GdCI, leads to lower systemic LPS tralising capacity (ENC) levels were concentrations in the recipient and measured in the portal vein and su-increases ENC values in the early perior vena cava after laparatomy, at phase after OLT. An improved the end of the anhepatic phase and hepatocellular LPS extraction a n d 1 h after reperfusion. During the or an activation of the extrahepatic anhepatic phase, the sigmoid pHi reticulo-endothelial system as a redecreased significantly from sult of GdC1, treatment is discussed.7.32 * 0.02 to 7.29 i 0.03 (P < 0.001) and was associated with a substan-

The study was designed to assess the gastrointestinal ischaemia and the influence of the specific Kupffer cell toxin gadolinium chloride (GdCl3) on the hepatic and extrahepatic endotoxin [lipopolysaccharide (LPS)] clearance during experimental orthotopic liver transplantation (OLT) in pigs. In eight pig liver transplantations, the donors received 20 mg/kg of GdCl3 24 h before explantation, while controls (n = 8) received normal saline. Gastric and sigmoid intramucosal pH (pHi), LPS and endotoxin-neutralising capacity (ENC) levels were measured in the portal vein and superior vena cava after laparatomy, at the end of the anhepatic phase and 1 h after reperfusion. During the anhepatic phase, the sigmoid pHi decreased significantly from 7.32 +/- 0.02 to 7.29 +/- 0.03 (P < 0.001) and was associated with a substantial increase of portal LPS. Following reperfusion, the systemic LPS concentrations were significantly lower in the pretreated group [39 +/- 23 pg/ml (Control); 14 +/- 7 (GdCl3); P < 0.05] suggesting an improved liver LPS clearance [86% (GdCl3); 58.2% (Control); P < 0.05]. This corresponded to an increased ENC in the pretreated group [118 +/- 52 ENU/ml (GdCl3) vs 81 +/- 45 ENU/ml (Control); P < 0.05]. The anhepatic phase induced splanchnic ischaemia which correlated with portal endotoxaemia. Donor preconditioning with GdCl3 leads to lower systemic LPS concentrations in the recipient and increases ENC values in the early phase after OLT. An improved hepatocellular LPS extraction and/or an activation of the extrahepatic reticulo-endothelial system as a result of GdCl3 treatment is discussed.