A technique for isolation perfusion of the canine liver with survival.

A technique of isolation perfusion of the canine liver was developed as a model for treating cancer limited to the liver. Preservation of hepatic functional integrity was dependent on maintenance of near physiologic conditions for the perfusion. Flow to the liver, 1 ml/min/g, was provided by gravity to the portal vein at two thirds total flow, and by pump to the hepatic artery at one third total flow. Utilizing the technique described, six dogs died 4-12 hr after a 1-hr perfusion. The dogs received Ringer's lactate solution IV and had a rising blood lactate to greater than 9 mM and a rising lactate/pyruvate ratio. After changing IV fluids to nonlactate containing solutions, 4/6 dogs survived a 1-hr perfusion at 37 degrees. Blood lactate concentrations remained below 6 mM (alpha less than 0.05) during perfusion, and the lactate/pyruvate ratios remained in a physiologic range on comparison to the nonsurvivors (alpha less than 0.05). Mild elevations occurred in the SGOT and SGPT with the peak on the first postoperative day of 93 +/- 54 and 79 +/- 56, respectively, but returned to normal within 4-7 days. Perfusate chemistries lactate, pyruvate, glucose, total alpha-amino acids, ketone bodies, SGOT, and SGPT demonstrated that hepatic functional integrity was maintained during the 1-hr perfusion. Hepatic function as assessed was no different between survivors and nonsurvivors. Hypoglycemia (glucose less than 2 mM) contributed to the two deaths. Tolerance of the dog to the temporary anhepatic state may be the limiting factor to prolonged perfusions.