A successful technique of in vivo isolated liver perfusion in pigs

A technique was developed to isolate the hepatic circulation from the general circulation using a double lumen intracaval shunt. Low flow normothermic perfusion of the liver was performed for 1 hr 25 min in pigs. All pigs survived the procedure. The isolated liver perfusion without chemotherapy (n = 11) was well tolerated as monitored by hepatic enzymes and histologic examination during and after the operation. Mild transient elevations of SGOT and LDH returned to normal values within 1 week. No significant pathological alterations were found in the liver biopsies. Twenty-two pigs were subjected to isolated liver perfusion with 20, 40, or 80 mg 5-FU/kg. Up to four times the conventional dose of the drug could safely be administered when a washout was performed. To evaluate the efficacy of the isolation a method for leakage detection was developed, using tracer quantities of 99mTc-labeled red blood cells. This method was sensitive and permitted continuous monitoring of leakage. Negligible leakage was found during 15 isolated liver perfusions. The described technique of isolated liver perfusion was a reliable and technically feasible method, and has been adapted for clinical use to evaluate its value in the treatment of hepatic metastases.