FIBRIN SEALANT OF THE CUT SURFACE OF PARTIAL LIVER GRAFTS FROM LIVINGDONORS

Complete hemostasis and proof against bile leakage on the cut surface of the partial fiver graft and the remnant liver of the donor are basi c desiderata for a successful outcome in living related liver transpla ntation (LRLT). This study evaluated the efficacy of fibrin glue seala nt on the cut surface of a graft in human living related fiver transpl antation and canine partial liver transplantation in terms of postoper ative complications, From June 1990 to August 1993, a series of 70 LRL Ts were performed on children with end-stage liver disease. In harvest ing the graft from living donor, hepatic parenchyma was transected by ultrasonic aspirator. Clearly exposed vessels were either ligated or s uture ligated. Fibrous connecting tissues of the glissonian branches a nd tiny vessels were coagulated by a newly devised bipolar electric ca utery equipped with saline dripping system. Fibrin sealant was sprayed on the cut surface of the liver graft and the remnant liver of the do nor. All donors were discharged from hospital at 10 to 17 (mean = 11.6 ) days after surgery without any complications that required surgical intervention, and were able to return to normal life. At reperfusion o f the graft in the recipients, no blood loss from the cut surface was observed. However, bile oozing on the cut surface was observed in 3 of the 70 cases. No infection or foreign body reactions were observed in the fibrin-sealed cut surface of the graft. Actuarial recipient survi val rate was 89% (48/54) in elective cases and 69% (11/16) in emergenc y cases. In canine transplantation, 16 out of 23 beagles survived for 4 days or longer (longest 20 days). No bleeding from the cut surface w as observed at revascularization of rite partial liver graft Upon auto psy after expiration, no definite infection on the cut surface was fou nd. The results indicate that fibrin sealant is effective for hemostas is and biliary proof on both the cut surface of the partial liver graf t and the remnant liver of the living donor.