The treatment of liver failure and hepatic coma remains unsatisfactory despite the use of substances designed to lower blood ammonia concentrations. The purpose of this paper is to describe the experimental basis for utilizing the isolated liver perfused by a pump oxygenator for lowering blood ammonia. The feasibility of utilizing this system in the clinical management of hepatic coma is discussed.
Materials and Methods
1. Perfusion Technique.
—During a 2½-year period a technique has evolved for the satisfactory perfusion of an isolated liver. A wide variety of perfusion systems, animal species, oxygenators, pumps, temperatures, flow rates, means of preparing the donor animal, and methods of handling donor blood have been investigated but need not here be reviewed.A 24- to 43-kg. pig (liver of 630 to 1,600 gm.) is given 1,000,000 units of penicillin and 1 gm. of streptomycin the evening prior to the experiment. The animal is premedicated 2