THE USE OF A PIG-LIVER XENOGRAFT FOR TEMPORARY SUPPORT OF A PATIENT WITH FULMINANT HEPATIC-FAILURE

A 26-year-old female patient with fulminant hepatic failure and a hist ory of autoimmune hepatitis was heterotopically transplanted with a pi g hepatic xenograft to provide temporary metabolic support prior to tr ansplantation with a human donor organ, Circulating natural antipig an tibodies were removed prior to transplantation by plasmapheresis and e x vivo en bloc perfusion of the donor pig kidneys. The Liver xenograft functioned after transplantation as measured by active bile productio n, stabilization of prothrombin levels, and reduction in the circulati ng levels of lactic acid and the enzymes AST and ALT. Despite the re m oval of greater than 90% of the recipient's natural xenoantibodies pri or to transplantation, the levels of antibody rapidly returned and wer e associated with antibody and complement-mediated rejection of the do nor graft. Immunohistochemical evidence of graft rejection could be de tected by the deposition of antibody, complement components including properdin, and endothelial swelling as early as 3 hr posttransplantati on These lesions progressed in severity and were accompanied by eviden ce of thrombosis and ischemic necrosis of the Liver xenograft by 34 hr s posttransplantation. The main portal vein, hepatic artery, and vena cava were patent. The placement of the liver graft did not result in a ny improvement in the neurological status of the patient and she died 34 hr after xenografting due to irreversible brain damage, The informa tion derived from this case has renewed interest in the clinical use o f bioartifical devices and whole organ perfusion using xenogeneic tiss ue for temporary bridging of patients prior to allografting.