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Zur Organkonservierung der Niere und Langzeitperfusion der Leber

  • W. E. Zimmermann
  • K. H. Rehfeld
  • B. Fischer
  • W. Braun
  • C. Bannert
  • R. Dierekmann
  • M. Mukasa
Chapter
Part of the Langenbecks Archiv für Chirurgie book series (LAC)

Zusammenfassung

Zur Verlängerung der Ischämietoleranz der Niere und anderer Organe wird eine Überdruck-Konservierungskarnmer nach klinischer Prüfung empfohlen. Die aus Plexiglas bestehende Kammer läßt einen Überdruck bis 8 atü zu und garantiert eine Temperaturkonstanz von 2–4°C. Im Deckel ist ein Druck-manometer, ein Einfüllstutzen und ein Reduzierventil sowie ein Thermofühler installiert. Sie wird als Transport-Konservierungskammer empfohlen, da dadurch (lie Hypothermie und gleichzeitige hyperbare Oxygenation Konservierungszeiten auch in der Humanmedizin bei der Transplantation der Niere von 8–11 Std möglich sind.

Summary

To lengthen ischaemia tolerance of the kidney and other organs an excess pressure preservation chamber is recommended after clinical tests. The chamber consists of plexiglass, permits an excess pressure of 8 kg/cm2 and ensures a constant temperature of 2–4°C. In the lid there is a pressure gauge, a filling socket and a reducing valve as well as a thermostat. A portable preservation chamber is recommended since, owing to hypothermia and simultaneous hyperbaric oxygenation, preservation periods of 8–11 hours are possible in kidney transplantation even in human surgery. In addition, an organ perfusion system is presented, consisting of a heart-lung machine with a pulsatory pump (hepatic artery) and two roller pumps (portal vein), a bubble oxygenator and heat exchanger as well as the organ perfusion chamber with the aid of which and with an excess pressure of 1/2 to lc/2 kg/cm2 perfusion periods of 30–40 hours are possible under hypothermia of 14¡ãC. It is necessary that the liver still in the donor’s body is cooled below 20°C during washing-out (15–20 min), to prevent primary hypoxia damage, and that it is only then switched over to perfusion with Hb-free solution. Alternating and rhythmic pressure changes of 1/2 kg/cm2 are considered especially important. Functional efficiency during long-term perfusion is confirmed by checking the passage of the characteristic liver enzymes (GLDH and GOT > 4.0 mU/ml, LDH > 180 mU/ml) into the perfusion solution, the active excretion of bengal-rose, measuring the lactate level and oxygen consumption. The performance of an organ preserved hypothermally and hyperbarically and perfused in this manner is demonstrated in heterologius liver replacement in man in hepatic coma.

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Literatur

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Copyright information

© Springer-Verlag Berlin Heidelberg 1969

Authors and Affiliations

  • W. E. Zimmermann
    • 1
  • K. H. Rehfeld
    • 1
  • B. Fischer
    • 1
  • W. Braun
    • 1
  • C. Bannert
    • 1
  • R. Dierekmann
    • 1
  • M. Mukasa
    • 1
  1. 1.Freiburg i. Br.Deutschland

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