SUMMARYSuccessful preservation of pig's liver using simple ice storage is described. The liver is apparently stored well by this method for 5-8 hours.LIVER preservation has proved to be difficult. It is known that next to the brain the liver is the most sensitive organ in the body to damage by ischaemia, and attempts to preserve it often fail. There are few methods of liver preservation for long periods of time which would be suitable in human liver transplantation (Brettschneider, Daloze, Porter, Groth, Hutchison, and Starzl, 1968;Belzer, May, Berry, Phil, and Lee, 1970; Marshall, Ashby, Hadjiyannakis, and Lines, 1970;Turner and Alican, 1970). The most successful liver-preservation technique was described by Brettschneider, Groth, and Starzl (1968) and Starlz (1969), using continuous hyperbaric perfusion.Efforts have been made to preserve livers in the University Department of Surgery at Cambridge for over 2 years, using several types of apparatus (hyperbaric and normobaric, with blood, serum, or plasma as the perfusate). I n general, the results have been so disappointing that we have concluded that a lethal toxic syndrome, apparently due to defects in preservation, occurred in almost all recipients after transplantation (Marshall and others, 1970). A similar result was gained with cooling without perfusion in a variety of protocols (Marshall and others, 1970). This paper concerns a satisfactory technique based on Schalm's method of simple ice storage of the pig's liver for 5-8 hours. The fundamental differences in technique were that we used a Hartman-solutionbased perfusate, rather than one based on dextran, to flush out the liver prior to perfusion with plasma, and we flushed out the liver immediately before revascularization with Hartman's solution containing additives. There were also differences in the perfusate additives (e.g., phenoxybenzamine was included) and these are listed in Table I .
METHODLarge White and Landrace-cross pigs of 20-24 kg.were used as donors and recipients and were unselected. The operative procedures of orthotopic liver-grafting have been described previously (Calne, Yoffa, White, and Maginn, 1968;Calne, 1969).In all donor animals, after hepatic ischaemia was induced, rapid intraportal infusion of I litre of chilled Hartman's solution plus 1000 U. heparin and 50 mg. phenoxybenzamine was started (750 ml. via the portal vein and 250 ml. via the hepatic artery), and continued with I litre of Hartman's solution until the effluent of the infrahepatic inferior vena cava was clear. The Hartman's solution was then replaced by (300-450 ml.) autologous chilled plasma-without any special treatment-containing 10 ml. 2 per cent procaine, 8 ml. 50 per cent dextrose, 20 ml. 1.4 per cent sodium bicarbonate, 50 mg. phenoxybenzamine, and 1000 U. heparin. Indomethacin, 50 mg., was also added to the plasma in half of the experiments.A Bardic cannula was inserted into the distal abdominal aorta and blood was collected in sterile bottles containing heparin for transfusion in the recipient.This cannu...
